Hemodialysis and hemodiafiltration differently modulate left ventricular diastolic function

Abstract

BackgroundRenal replacement therapy may have a favorable effect on diastolic left ventricular function, but it is not clear whether hemodiafiltration is superior to hemodialysis in this field. Nitric oxide (NO) and asymmetric dimethylarginine (ADMA) may play a role in the changes of intracardiac hemodynamics, but it is not clear whether the different renal replacement methods have disparate influence on the metabolism of these materials.MethodsThirty patients on renal replacement therapy were investigated. First, data was analyzed while patients received hemodiafiltration over a period of three months. Then, the same patients were evaluated during treatment with hemodialysis for at least another three months. Echocardiography was performed before and after renal replacement therapy.ResultsNo significant difference was found in the volume removals between hemodialysis and hemodiafiltration. The left atrial diameter and transmitral flow velocities (E/A) decreased significantly only during hemodiafiltration. A positive correlation was observed between the left atrial diameter and E/Ea representing the left ventricular pressure load during hemodiafiltration. Significant correlations between NO and A and E/A were observed only in the case of hemodiafiltration.ConclusionHemodiafiltration has a beneficial effect on echocardiographic markers representing left ventricular diastolic function. This could be attributed to the differences between the dynamics of volume removal and its distribution among liquid compartments.

Hemodialysis‐induced cardiovascular disease

“…94 The most recent randomized clinical trial in the United States failed to show a difference in 5-year survival between PD and HD. 95 Hemodiafiltration may have a beneficial effect on left ventricular diastolic function compared to HD according to one cross-over trial. 96 However, intradialytic cardiac magnetic resonance imaging on 12 patients randomly allocated to either HD or HF showed insufficient evidence for a significant difference between the two treatment modalities on cardiovascular responses to dialysis; the limited number of patients evaluated may account for the inconsistent findings.…”

Comparison of the effects of hemodialysis and hemodiafiltration on left ventricular hypertrophy in end‐stage renal disease patients: A systematic review and meta‐analysis

“…The length of follow-up of measurements was extremely heterogeneous with a range of 3 months to 4 years. [15][16][17][18][19]22,23 In conclusion, we found no benefits of HDF over conventional HD with respect to improvement of LVMi and EF in ESRD patients.…”

“…Our meta‐analysis comprised studies with heterogeneous convection volumes. In the study by Czifra et al, a mean of 15.1 ± 5.0 L of ultrafiltrate was removed . Mostovaya et al included a subset of patients participating in the CONTRAST study and used different convection volumes.…”

“…Moreover, the number of studies included in the analysis was relatively small and only two studies were prospective, randomized, controlled trials. The length of follow‐up of measurements was extremely heterogeneous with a range of 3 months to 4 years …”

“…In the study by Czifra et al, a mean of 15.1 ± 5.0 L of ultrafiltrate was removed. 15 Mostovaya et al included a subset of patients participating in the CONTRAST study and used different convection volumes. However, high convection volumes (>18.8 L) was not related to change of left ventricular mass and EF.…”