Effect of hemodialysis on blood volume distribution and cardiac output.

Chaignon, M; Chen, W T; Tarazi, Robert C.; Bravo, Emmanuel L.; Nakamoto, Satoru

doi:10.1161/01.hyp.3.3.327

Cited by 69 publications

(32 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The cardiac alteration documented is attributable to chronic increased cardiac work, that can be caused by sodium and water retention, presence of AVF, arterial hypertension and anemia [21] . Other authors have shown that the interdialytic body weight increment (the index of sodium and water retention), directly correlates with LV mass [22] ; in our patients, however, this value did not change during the study. Similarly, the fl ow rate in the vascular access remained unvaried.…”

Section: Discussioncontrasting

confidence: 77%

Efficacy of Erythropoietin on Dialysis in Patients with Beta Thalassemia Minor

Iorio¹,

Nicola²,

Bellizzi³

et al. 2004

Blood Purif

View full text Add to dashboard Cite

Background: It is unknown whether chronic erythropoietin (EPO) treatment is able to normalize hemoglobin (Hb) levels and ameliorate cardiac remodeling avoiding blood transfusions in uremic blood transfusion-dependent patients with β-thalassemia minor (β-thal). Methods: In 12 hemodialysis (HD) patients with β-thal, requiring blood transfusions despite EPO therapy, we planned to increase Hb levels up to the target levels (11–12 g/dl) within a one-year period by administering progressively higher doses of EPO (correction phase). We also planned to maintain the Hb target for an additional year (maintenance phase). Results: In the year before the study, patients required 3.3 ± 0.9 units of packed red blood cells. At baseline, the Hb level obtained with an EPO dose of 212 ± 73 U/kg/week i.v. was 8.2 ± 0.8 g/dl. The EPO dose was gradually increased within the first year up to 458 ± 78 U/kg/week at month 12 (correction phase) and then significantly tapered down during the maintenance phase (390 ± 54 U/kg/week at month 24). During the correction phase, the Hb levels markedly increased (11.1 ± 0.3 g/dl at month 12) and did not change in the maintenance phase. No blood transfusion was required throughout the 2 years of follow-up. Left ventricular (LV) mass index progressively decreased from the basal value of 144 ± 12 to 124 ± 11 g/m² in the first year and normalized in all patients at month 24 (109 ± 12 g/m², p < 0.001); this occurred in the absence of any change of LV cavity volume index (<90 ml/m²). Conclusions: In HD transfusion-dependent patients with β-thal, the administration of high EPO dose for 2 years permits the attainment and the maintenance of Hb targets without blood transfusions. This therapeutic approach permits a complete remission of concentric LV hypertrophy without any adverse effects on the vascular system.

show abstract

Section: Discussioncontrasting

confidence: 77%

Efficacy of Erythropoietin on Dialysis in Patients with Beta Thalassemia Minor

Iorio¹,

Nicola²,

Bellizzi³

et al. 2004

Blood Purif

View full text Add to dashboard Cite

show abstract

“…Within the frequent dialysis group, interdialytic weight gain was associated with neither changes in LV mass (6) nor changes in LVEDV (7). These findings are similar to those of an earlier study that found no significant correlation between changes in total volume and changes in LVEDV (22). On the basis of this finding, we propose that changes in LVEDV induced by hemodialysis may not be related solely to changes in total blood volume, which would be reflected in changes in the interdialytic weight; decreased LVEDV may also result from a peripheral relocation of the blood volume away from the heart.…”

supporting

confidence: 90%

The Effects of Frequent Hemodialysis on Left Ventricular Mass, Volumes, and Geometry

Mishra

Dubin

2013

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Left ventricular (LV) remodeling is defined as ''the genomic expression resulting in molecular, cellular, and interstitial changes that are manifested clinically as changes in size, shape, and function of the heart after cardiac injury" (1). In ESRD, LV remodeling manifests features of both concentric and eccentric LV hypertrophy, resulting from enlarged LV volumes and increased LV wall thickness (2). As we discuss here, LV mass can change because of a change in LV wall thickness, LV cavity size, or both. Increased LV mass, increased LV end-diastolic volume (LVEDV), and changes in LV geometry (LV mass/LVEDV) are all associated with poor prognosis in these patients (3,4). The Frequent Hemodialysis Network (FHN) trial is the first large-scale randomized controlled trial of frequent daily and nocturnal dialysis versus conventional dialysis (5). FHN investigators previously demonstrated that, compared with conventional hemodialysis, frequent daily hemodialysis results in a significantly greater reduction in LV mass, as determined by cardiac magnetic resonance imaging (MRI) (6). In this issue of CJASN, this group reports that frequent daily dialysis resulted in greater reductions in LV and right ventricular (RV) volumes without significant changes in LV geometry (7). In addition, reductions in both LV mass and LVEDV with frequent dialysis were significantly correlated with reductions in predialysis systolic BP (6,7). Here we present a brief overview of the literature on the effects of dialysis on LV remodeling, discuss likely mechanisms underlying the findings of the current study, and reflect on implications for future investigation.Observational studies of frequent dialysis have shown salutary effects on BP (8-11) and LV mass index (12-15) and impressive survival rates (8,16). Moreover, LV hypertrophy has regressed in patients with ESRD who have baseline LV hypertrophy when aggressive management of BP and anemia was added to a thrice-weekly dialysis regimen (17,18). One such study shows that LV hypertrophy may regress without a change in relative wall thickness, another measure of LV geometry (18). In several studies, including the FHN trial, lowering BP was strongly associated with regression of LV hypertrophy (9,10,(12)(13)(14). Prior studies of frequent dialysis that evaluated LV size in addition to mass did not specifically address LV geometry (10,13).LV mass and volume are linked mathematically, physiologically, and empirically. Cardiac MRI is widely considered to be the gold standard for determining LV volume and mass, while M-mode echocardiography overestimates LV mass in patients with ESRD undergoing hemodialysis because of its geometric assumptions (19). In cardiac MRI, LV mass is calculated as myocardial volume multiplied by the specific density of the myocardium (20). Myocardial volume, in turn, is the difference between the enddiastolic epicardial volume and end-diastolic endocardial volume, excluding the papillary muscles (LVEDV). Thus, while MRI-determined LV mass is free of geometric assumptions, it ...

show abstract

“…Observational studies in ESRD suggest that solute and water retention contribute to hypertension, LV hypertrophy, and congestive heart failure (23). The presence of a dilated ventricle (as measured by LVEDV) has been associated with much higher risk than the risk predicted by elevation in LVM alone (2,3).…”

Section: Discussionmentioning

confidence: 99%

Effects of Frequent Hemodialysis on Ventricular Volumes and Left Ventricular Remodeling

Chan

Greene

Chertow

et al. 2013

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

SummaryBackground and objectives Higher left ventricular volume is associated with death in patients with ESRD. This work investigated the effects of frequent hemodialysis on ventricular volumes and left ventricular remodeling.Design, setting, participants, & measurements The Frequent Hemodialysis Network daily trial randomized 245 patients to 12 months of six times per week versus three times per week in-center hemodialysis; the Frequent Hemodialysis Network nocturnal trial randomized 87 patients to 12 months of six times per week nocturnal hemodialysis versus three times per week predominantly home-based hemodialysis. Left and right ventricular end systolic and diastolic volumes, left ventricular mass, and ejection fraction at baseline and end of the study were ascertained by cardiac magnetic resonance imaging. The ratio of left ventricular mass/left ventricular end diastolic volume was used as a surrogate marker of left ventricular remodeling. In each trial, the effect of frequent dialysis on left or right ventricular end diastolic volume was tested between predefined subgroups.

show abstract

Effect of hemodialysis on blood volume distribution and cardiac output.

Cited by 69 publications

References 26 publications

Efficacy of Erythropoietin on Dialysis in Patients with Beta Thalassemia Minor

Efficacy of Erythropoietin on Dialysis in Patients with Beta Thalassemia Minor

The Effects of Frequent Hemodialysis on Left Ventricular Mass, Volumes, and Geometry

Effects of Frequent Hemodialysis on Ventricular Volumes and Left Ventricular Remodeling

Contact Info

Product

Resources

About