Hemodialysis-Induced Regional Left Ventricular Systolic Dysfunction

Assa, Solmaz; Hummel, Yoran M.; Voors, Adriaan A.; Kuipers, Johanna; Westerhuis, Ralf; Jong, Paul E. de; Franssen, Casper F. M.

doi:10.2215/cjn.00850112

Cited by 101 publications

(109 citation statements)

References 27 publications

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“…Regional assessment of myocardial contractility in tandem with perfusion allowed us to study the development of myocardial stunning more precisely, demonstrating co-existing reductions in contractile function and perfusion and only partial recovery postdialysis. The pattern of injury, and peak of the effect, was in keeping with echocardiography-based studies performed by our group and others [6,23]. We observed myocardial stunning as early as 70min from the start of treatment, consistent with early changes in myocardial perfusion described in PET studies [9].…”

Section: Discussionsupporting

confidence: 90%

“…However, using data from previous echocardiography-based studies and assuming a mean±SD of 4.81.3 new regional wall motion abnormalities (RWMAs) per patient with standard dialysis [33] [33], 11 patients per group would be required to have a 90% chance of detecting a decrease in new RWMAs from 4.8 in standard dialysis to 3.0 in the HDF group, significant at the 5% level. Such a reduction would be clinically significant and in keeping with other dialysis based interventions shown previously to reduce dialysisinduced myocardial stunning [23,33]. to HD or HDF for two weeks, after which they attended a cardiac MRI scan which was performed before, during, and after a dialysis session.…”

Section: Cardiac Imagingsupporting

confidence: 67%

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Intradialytic Cardiac Magnetic Resonance Imaging to Assess Cardiovascular Responses in a Short-Term Trial of Hemodiafiltration and Hemodialysis

Buchanan

Mohammed

Cox

et al. 2016

JASN

129

118

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Hemodynamic stress during hemodialysis (HD) results in recurrent segmental ischemic injury (myocardial stunning) that drives cumulative cardiac damage. We performed a fully comprehensive study of the cardiovascular effect of dialysis sessions using intradialytic cardiac magnetic resonance imaging (MRI) to examine the comparative acute effects of standard HD versus hemodiafiltration (HDF) in stable patients. We randomly allocated 12 patients on HD (ages 32–72 years old) to either HD or HDF. Patients were stabilized on a modality for 2 weeks before undergoing serial cardiac MRI assessment during dialysis. Patients then crossed over to the other modality and were rescanned after 2 weeks. Cardiac MRI measurements included cardiac index, stroke volume index, global and regional contractile function (myocardial strain), coronary artery flow, and myocardial perfusion. Patients had mean±SEM ultrafiltration rates of 3.8±2.9 ml/kg per hour during HD and 4.4±2.5 ml/kg per hour during HDF (P=0.29), and both modalities provided a similar degree of cooling. All measures of systolic contractile function fell during HD and HDF, with partial recovery after dialysis. All patients experienced some degree of segmental left ventricular dysfunction, with severity proportional to ultrafiltration rate and BP reduction. Myocardial perfusion decreased significantly during HD and HDF. Treatment modality did not influence any of the cardiovascular responses to dialysis. In conclusion, in this randomized, crossover study, there was no significant difference in the cardiovascular response to HDF or HD with cooled dialysate as assessed with intradialytic MRI.

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Section: Discussionsupporting

confidence: 90%

Section: Cardiac Imagingsupporting

confidence: 67%

Intradialytic Cardiac Magnetic Resonance Imaging to Assess Cardiovascular Responses in a Short-Term Trial of Hemodiafiltration and Hemodialysis

Buchanan

Mohammed

Cox

et al. 2016

JASN

129

118

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“…HD itself causes recurrent and cumulative ischemic injury to the heart, brain, and other organs (2). Recurrent HD-induced myocardial stunning results in long-term contractile dysfunction, abnormal ventricular morphology, and increased mortality (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Randomized Controlled Trial of Individualized Dialysate Cooling for Cardiac Protection in Hemodialysis Patients

Odudu

Eldehni

McCann

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Cardiovascular disease is the most common cause of death in patients on hemodialysis (HD). HD-associated cardiomyopathy is appreciated to be driven by exposure to recurrent and cumulative ischemic insults resulting from hemodynamic instability of conventionally performed intermittent HD treatment itself. Cooled dialysate reduces HD-induced recurrent ischemic injury, but whether this confers long-term protection of the heart in terms of cardiac structure and function is not known.Design, setting, participants, & measurements Between September 2009 and January 2013, 73 incident HD patients were randomly assigned to a dialysate temperature of 37°C (control) or individualized cooling at 0.5°C below body temperature (intervention) for 12 months. Cardiac structure, function, and aortic distensibility were assessed by cardiac magnetic resonance imaging. Mean between-group difference in delivered dialysate temperature was 1.2°C60.3°C. Treatment effects were determined by the interaction of treatment group with time in linear mixed models.Results There was no between-group difference in the primary outcome of left ventricular ejection fraction (1.5%; 95% confidence interval, -4.3% to 7.3%). However, left ventricular function assessed by peak systolic strain was preserved by the intervention (-3.3%; 95% confidence interval, -6.5% to -0.2%) as was diastolic function (measured as peak diastolic strain rate, 0.18 s 21 ; 95% confidence interval, 0.02 to 0.34 s 21 ). Reduction of left ventricular dilation was demonstrated by significant reduction in left ventricular end-diastolic volume (-23.8 ml; 95% confidence interval, -44.7 to -2.9 ml). The intervention was associated with reduced left ventricular mass (-15.6 g; 95% confidence interval, -29.4 to -1.9 g). Aortic distensibility was preserved in the intervention group (1.8 mmHg 21 310 23 ; 95% confidence interval, 0.1 to 3.6 mmHg 21 310 23 ). There were no intervention-related withdrawals or adverse events.

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“…However, some previous studies showed a lower incidence of HD-induced reduction of EF. 15,16 It can be explained by the absence of diabetes and pre-existing cardiac disease in their study population. A second explanation might be the difference in the method used for the evaluation of regional LV systolic dysfunction.…”

Section: -14mentioning

confidence: 94%

“…Because one study showed that reduction of EF was different during different time of HD and mostly occurred during early phase of HD. 15 However, some studies showed that repeated HD may improve LV dysfunction over time. 26,27 As our study was only two-session study, our study did not support this finding.…”

Section: -14mentioning

confidence: 99%

Echocardiographic assessment of cardiac dysfunction in maintenance hemodialysis patients

Alam

Hossain

2017

Bangladesh Crit Care J

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Background and Objectives: The hemodialysis (HD) procedure may acutely induce regional left ventricular systolic dysfunction. This study evaluated the echocardiographic parameters in patients with End Stage Renal Disease (ESRD) on HD and to correlate those with clinical findings, more specifically to see whether there is any change in ejection fraction (EF) by developing new regional wall motion abnormality (RWMA) after hemodialysis, and to correlate these changes with the symptoms & hemodynamic condition of the patients.Methodology: This prospective observational study was carried on a total of 100 adult ambulant patients with end stage renal disease (ESRD) on maintenance hemodialysis in the department of Hemodialysis, BIRDEM General Hospital, Shahbag, Dhaka. Their echocardiogram was done 30 min before and after the hemodialysis.Result: It was revealed that majority of the patients were above 60 years (39%), and male to female ratio of about 3:2. The study subjects had diabetes mellitus (79%), hypertension (96%), dyslipidemia (42%), and family history of ischemic heart disease (24%). Chest pain and breathlessness were present in 31% and 42% subjects respectively before hemodialysis. Palpitation (23%), dizziness (19%), oedema (43%) and raised JVP (15%) were seen in the study subjects. Mean (±SD) serum creatinine level was 9.38 (±2.22) mg/dl and hemoglobin level was 9.0 (±1.08) g/dl. Ejection fraction (EF) before hemodialysis were ?55, 40-54 & 30-39 in 62%, 34% and 4% study subjects respectively and after hemodialysis it was ?55, 40-54 & 30-39 in 44%, 46% and 10% study subjects respectively. After HD, left ventricular failure (LVF) occurred in 32% subjects. HD-induced regional left ventricular systolic dysfunction occurred in total 36 patients (36%) and total 14 (14%) patients developed LVF 30 minutes after dialysis. Patients with hemodialysis-induced left ventricular systolic dysfunction were more in those who had worse predialysis EF. Blood pressure, heart rate, chest pain, palpitation, raised Jugular Venous Pressure (JVP) and edema did not differ significantly before and after hemodialysis. Simple regression analysis revealed that the hemodialysis procedure significantly (P<0.05) induce regional left ventricular systolic dysfunction.Conclusions: HD acutely induces regional wall motion abnormalities in a significant proportion of patients. It occurs within 30 min after hemodialysis and is not related to changes in blood pressure, heart rate, JVP and oedema.Bangladesh Crit Care J September 2017; 5(2): 97-100

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Hemodialysis-Induced Regional Left Ventricular Systolic Dysfunction

Cited by 101 publications

References 27 publications

Intradialytic Cardiac Magnetic Resonance Imaging to Assess Cardiovascular Responses in a Short-Term Trial of Hemodiafiltration and Hemodialysis

Intradialytic Cardiac Magnetic Resonance Imaging to Assess Cardiovascular Responses in a Short-Term Trial of Hemodiafiltration and Hemodialysis

Randomized Controlled Trial of Individualized Dialysate Cooling for Cardiac Protection in Hemodialysis Patients

Echocardiographic assessment of cardiac dysfunction in maintenance hemodialysis patients

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