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

Buchanan, Charlotte; Mohammed, Azharuddin; Cox, Eleanor; Köhler, Katrin; Canaud, Bernard; Taal, Maarten W.; Selby, Nicholas M.; Francis, Susan T.; McIntyre, Christopher W.

doi:10.1681/asn.2016060686

Cited by 130 publications

(133 citation statements)

References 34 publications

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“…Intermittent RRT is associated with cardiac stunning in both chronic and acute settings. In CKD patients, intermittent RRT results in new regional impairment of LV contractility on echocardiography and dose‐dependent reduction in myocardial perfusion despite preserved coronary blood flow measured using cardiac MRI and PET, suggesting microcirculatory rather than global hemodynamic mechanism of injury . Repeated 3 to 5 times weekly in chronic HD settings, cardiac stunning accumulates leading to irreversible reduction in LV systolic function and dose‐dependent increase in mortality .…”

Section: Discussionmentioning

confidence: 99%

“…In chronic kidney disease (CKD) patients, intermittent hemodialysis (HD) is associated with significant segmental reduction in myocardial perfusion, resulting in cardiac stunning ‐ detected as new regional impairment of left ventricular (LV) contractile function with transthoracic echocardiography . Repeated thrice weekly in chronic HD, this cardiac stunning accumulates, leading to fixed reduction in LV systolic function, that is, associated with dose‐dependent increase in mortality .…”

Section: Introductionmentioning

confidence: 99%

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Continuous renal replacement therapy is associated with acute cardiac stunning in critically ill patients

Slessarev

Salerno

Ball

et al. 2019

Hemodialysis International

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Introduction: Intermittent renal replacement therapy induces cardiac stunning in chronic hemodialysis and acute kidney injury (AKI) patients. In chronic hemodialysis, recurrent stunning contributes to heart failure and cardiac death, with ultrafiltration and intradialytic hypotension being the principal determinants of this injury. Continuous renal replacement therapy (CRRT), with its lower ultrafiltration rates and improved hemodynamic profile, should protect against cardiac stunning in AKI. The objective of this study was to assess whether CRRT is associated with cardiac stunning in critically ill patients with AKI. Methods: We prospectively measured cardiac function using global and segmental longitudinal left ventricular strain using transthoracic echocardiography in 11 critically ill patients who were started on CRRT for AKI. We compared measurements at 4, 8, and 24 hours to baseline immediately prior to initiation of CRRT, with each patient serving as their own control. We also recorded blood pressure, heart rate, dose of vasoactive medications and intensive care unit mortality. Findings: Ten of 11 patients developed new regional cardiac stunning, with 8/11 within 4 hours of starting CRRT, despite stable hemodynamics. The number of affected left ventricular segments varied from 1 to 11 (out of 12). The stunning occurred both in patients with preserved and impaired baseline cardiac function, and 7/11 patients died in the intensive care unit. Discussion: Initiation of CRRT in critically ill patients with AKI is associated with cardiac stunning despite stable hemodynamics. This mechanism may explain lack of clinical benefit of CRRT over intermittent modalities and warrants further investigation to improve cardiovascular outcomes in critically ill patients with AKI.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Continuous renal replacement therapy is associated with acute cardiac stunning in critically ill patients

Slessarev

Salerno

Ball

et al. 2019

Hemodialysis International

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“…Moreover, the long interdialytic interval imposes higher ultrafiltration rates, which are inherently associated with increased mortality and also with reduced perfusion of vital organs such as the brain and the heart [49,50]. Therefore, the long interdialytic interval may be detrimental because of aggravating fluid overload and the risk of hyperkalemia during the end of the long interdialytic interval and increase in hemodynamic stress and electrolyte imbalance during the first HD session of the week.…”

Section: Imposed Time Schedules: the Thrice Weekly Schedulementioning

confidence: 99%

Cycles, Arrows and Turbulence: Time Patterns in Renal Disease, a Path from Epidemiology to Personalized Medicine?

et al. 2018

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Patients with end-stage renal disease (ESRD) experience unique patterns in their lifetime, such as the start of dialysis and renal transplantation. In addition, there is also an intricate link between ESRD and biological time patterns. In terms of cyclic patterns, the circadian blood pressure (BP) rhythm can be flattened, contributing to allostatic load, whereas the circadian temperature rhythm is related to the decline in BP during hemodialysis (HD). Seasonal variations in BP and interdialytic-weight gain have been observed in ESRD patients in addition to a profound relative increase in mortality during the winter period. Moreover, nonphysiological treatment patters are imposed in HD patients, leading to an excess mortality at the end of the long interdialytic interval. Recently, new evidence has emerged on the prognostic impact of trajectories of common clinical and laboratory parameters such as BP, body temperature, and serum albumin, in addition to single point in time measurements. Backward analysis of changes in cardiovascular, nutritional, and inflammatory parameters before the occurrence as hospitalization or death has shown that changes may already occur within months to even 1–2 years before the event, possibly providing a window of opportunity for earlier interventions. Disturbances in physiological variability, such as in heart rate, characterized by a loss of fractal patterns, are associated with increased mortality. In addition, an increase in random variability in different parameters such as BP and sodium is also associated with adverse outcomes. Novel techniques, based on time-dependent analysis of variability and trends and interactions of multiple physiological and laboratory parameters, for which machine-learning approaches may be necessary, are likely of help to the clinician in the future. However, upcoming research should also evaluate whether dynamic patterns observed in large epidemiological studies have relevance for the individual risk profile of the patient.

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“…Note that such AVF-induced RV dilation has been independently associated with increased risk of death [9]. Buchanan et al [46] recently performed a comprehensive study of the cardiovascular impact of HD sessions using intradialytic cardiac MRI in 12 stable patients. Cardiac MRI measurements included cardiac index, stroke volume index, global and regional contractile function (myocardial strain), coronary artery flow and myocardial perfusion.…”

Section: Haemodynamic Impacts Of High-flow Avf In Patients Under Chromentioning

confidence: 99%

“…All patients experienced some degree of segmental LV dysfunction, with severity proportional to ultrafiltration rate and BP reduction. Myocardial perfusion decreased significantly during HD session [46]. In a single centre between 2003 and 2006, Movilli et al [47] enrolled 25 consecutive HD patients who underwent AVF ligation and conversion to a tunnelled central venous catheter, and compared them with 36 controls with a well-functioning AVF.…”

Section: Haemodynamic Impacts Of High-flow Avf In Patients Under Chromentioning

confidence: 99%

Controversies in the management of the haemodialysis-related arteriovenous fistula following kidney transplantation

Vanderweckene

Weekers

Lancellotti

et al. 2017

Clinical Kidney Journal

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Arteriovenous fistula (AVF) is regarded as the best vascular access for chronic haemodialysis (HD). Still, AVF inherently causes significant haemodynamic changes. Although the necessity for vascular access despite its putative cardiovascular complications favours AVF creation in patients under chronic HD, one may question whether sustaining a functional AVF after successful kidney transplantation extends the haemodynamic threat. Small prospective series suggest that AVF ligation causes rapid and sustained reduction in left ventricular hypertrophy. Still, the benefits of such a cardiac remodelling in long-terms of cardiovascular morbi-mortality still need to be proven. Furthermore, the elevation of diastolic blood pressure and arterial stiffness caused by AVF ligation may blunt the expected cardio-protection. Finally, the closure of a functioning AVF may accelerate the decline of kidney graft function. As a whole, the current management of a functioning AVF in kidney transplant recipients remains controversial and does not rely on strong evidence-based data. The individual risk of graft dysfunction and a return to chronic HD also needs to be balanced. Careful pre-operative functional assessments, including cardio-pulmonary testing and estimated glomerular filtration rate slope estimation, may help better selection of who might benefit the most from AVF closure. Large-scale prospective, ideally multi-centric, trials are essentially needed.

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

Cited by 130 publications

References 34 publications

Continuous renal replacement therapy is associated with acute cardiac stunning in critically ill patients

Continuous renal replacement therapy is associated with acute cardiac stunning in critically ill patients

Cycles, Arrows and Turbulence: Time Patterns in Renal Disease, a Path from Epidemiology to Personalized Medicine?

Controversies in the management of the haemodialysis-related arteriovenous fistula following kidney transplantation

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