Hemodialysis‐induced regional left ventricular systolic dysfunction

Abstract

Introduction Hemodialysis (HD) patients are under observably elevated cardiovascular mortality. Cardiac dysfunction is closely related to death caused by cardiovascular diseases (CVD). In the general population, repetitive myocardial ischemia induced left ventricular (LV) dysfunction may progress to irreversible loss of contraction step by step, and finally lead to cardiac death. In HD patients, to remove water and solute accumulated from 48 or 72 hours of interdialysis period in a 4-hour HD session will induce myocardial ischemia. In this study, we evaluated the prevalence and potential risk factors associated with HD-induced LV systolic dysfunction and provide some evidences for clinical strategies. Methods We recruited 31 standard HD patients for this study from Fudan University Zhongshan hospital. Echocardiography was performed predialysis, at peak stress during HD (15 minutes prior to the end of dialysis), and 30 minutes after HD. Auto functional imaging (AFI) was used to assess the incidence and persistence of HD-induced regional wall motion abnormalities (RWMAs). Blood samples were drawn to measure biochemical variables. Findings Among totally 527 segments of 31 patients, 93.54% (29/31) patients and 51.40% (276/527) segments were diagnosed as RWMAs. Higher cTnT (0.060 ± 0.030 vs. 0.048 ± 0.015 ng/mL, P = 0.023), phosphate (2.07 ± 0.50 vs. 1.49 ± 0.96 mmol/L, P = 0.001), UFR (11.00 ± 3.89 vs. 8.30 ± 2.66 mL/Kg/h, P = 0.039) and lower albumin (37.83 ± 4.48 vs. 38.38 ± 2.53 g/L, P = 0.050) were found in patients with severe RWMAs (RWMAs in more than 50% segments). After univariate and multivariate analysis, interdialytic weight gain (IDWG) was found as independent risk factor of severe RWMAs (OR = 1.047, 95%CI 1.155-4.732, P = 0.038). Discussion LV systolic dysfunction induced by HD is prevalent in conventional HD patients and should be paid attention to. Patients would benefit from better weight control during interdialytic period to reduce ultrafiltration rate.

Long‐term impacts of hemodialysis on the right ventricle: Assessment via 3‐dimensional speckle‐tracking echocardiography

“…On the other hand, excessive and rapid fluid removal leads to hemodynamic instability with the absence of a proper and timely compensatory mechanism. Moreover, hemodialysis‐induced myocardial stunning driven by ischemia has also been widely recognized . IDH is an important complication as a result of an inadequate CV response to large and rapid removal of volume.…”

Dialytic hemodynamics are associated with changes in gait speed

“…8,19 However most studies have not focused on changes in physical performance over the course of a dialysis session, nor evaluated HD specific risk factors for impairment in performance. Although it is known that the HD process can lead to cardiac stress and post dialysis fatigue 10,20,21 the effect on physical performance has not been well quantified. The role of HD specific risk factors in physical performance impairment needs further exploration.…”

Associação entre concentração de cálcio no dialisato e função ventricular sistólica durante a hemodiálise

“…Yuxin e colaboradores, utilizando uma técnica ecocardiográfica baseada em análise do strain ventricular, demonstraram a presença de AMPR's em 93% de 31 pacientes, associando sua gravidade (≥ 50% dos segmentos do VE acometidos) aos níveis de TnT e fósforo pré-diálise, ganho de peso interdialítico e à taxa de ultrafiltração. Após ajustes em regressão multivariada, somente o ganho de peso interdialítico se manteve como fator de risco independente 47 .…”

“…Ela é um marcador confiável do estado nutricional dos pacientes em HD e está associada a marcadores inflamatórios como citocinas e proteínas de fase aguda 53,54 . Estudos têm sugerido uma associação entre hipoalbuminemia e disfunção ventricular induzida pela HD com ocorrência de maior frequência de AMPR's durante o procedimento 47 .…”

“…A análise de função segmentar foi realizada avaliando a mobilidade de 17 segmentos do VE. Os segmentos que demonstraram uma redução, em valores absolutos, do pico do strain miocárdico > 20%, do basal para o pico da HD, foramdefinidos como AMPR's, denotando presença de disfunção segmentar, conforme literatura prévia47 . O SLG foi calculado como a média do strain em todos os segmentos.…”