Myocardial Alterations during Hemodialysis: Insights from New Noninvasive Technology

Singh, Narendra; Langer, Anatoly; Freeman, Michael R.; Goldstein, Marc B.

doi:10.1159/000168710

Cited by 38 publications

(19 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The characterization of these defects is difficult since some worsen while others improve with dialysis (tables 2, 3). This phenomenon has been found in a previous study using sestamibi imaging in dialysis patients [15]. …”

Section: Discussionsupporting

confidence: 80%

Comparison of Myocardial Perfusion during Hemodialysis and Hemodiafiltration

Andrade

Kotze

Lesosky³

et al. 2014

Nephron Clin Pract

View full text Add to dashboard Cite

Background: We compared myocardial perfusion in patients first on conventional hemodialysis (HD) and then on hemodiafiltration (HDF). Methods: Myocardial perfusion scintigraphy was performed in 25 patients pre- and post-HD. Patients were then converted to HDF for 3 months prior to repeating the scintigraphy. ^99mTc-methoxyisobutylisonitrile was administered intravenously pre-dialysis and then within the last hour of dialysis. Up to 90 min after injection, tomographic images were obtained. Clinical and laboratory data were collected pre- and post-dialysis. Results: Five patients did not complete the study. Patients entering the study were on average 41.7 years old and on HD for 4 years (median). The mean standard Kt/V for the two procedures was not statistically different (1.55 for HD and 1.48 for HDF). The mean substitution volume for HDF was 18.48 liters. There were no significant differences in changes in blood pressures between HD and HDF (p = 0.22). There were no significant differences in myocardial perfusion defects in patients on HD compared with those on HDF. During dialysis in both studies, the data showed a general trend to worsening of perfusion defects. Conclusions: There was no advantage of HDF over HD with no statistical difference in perfusion defects between HD and HDF. There was a trend to worsening of perfusion defects during dialysis in the majority on HD and HDF. Midweek dialysis perfusion scores appeared to be consistently lower than early-week dialysis, but this was not statistically significant. The pathogenesis of the defects may lie at a microcirculatory level.

show abstract

Section: Discussionsupporting

confidence: 80%

Comparison of Myocardial Perfusion during Hemodialysis and Hemodiafiltration

Andrade

Kotze

Lesosky³

et al. 2014

Nephron Clin Pract

View full text Add to dashboard Cite

show abstract

“…Repeated episodes of stunning are cumulative and contribute to the pathophysiology of heart failure (4). We and other investigators have previously shown evidence that subclinical ischemia occurs in response to the stress of hemodialysis (5)(6)(7). We also demonstrated that it was possible to reduce the frequency and the severity of this phenomenon by using biofeedback dialysis (Hemocontrol, Gambro-Hospal, Mirandora, Italy) to improve the hemodynamic tolerability of dialysis.…”

mentioning

confidence: 59%

Dialysis-Induced Regional Left Ventricular Dysfunction Is Ameliorated by Cooling the Dialysate

Selby

Burton

Chesterton

et al. 2006

Clinical Journal of the American Society of Nephrology

155

166

View full text Add to dashboard Cite

Dialysis patients who develop cardiac failure have a poor prognosis. Recurrent subclinical myocardial ischemia is important in the genesis of heart failure in nondialysis patients. It has previously been demonstrated that subclinical ischemia occurs during hemodialysis; therefore, this study examined whether the improved stability of cool-temperature dialysis lessens this phenomenon. Ten patients who were prone to intradialytic hypotension entered a randomized, crossover study to compare the development of dialysis-induced left ventricular (LV) regional wall motion abnormalities (RWMA) at dialysate temperatures of 37 and 35°C. Serial echocardiography with quantitative analysis was used to assess ejection fraction and regional systolic LV function. BP and hemodynamic variables were measured using continuous pulse wave analysis. The severity of thermal symptoms was scored using a simple questionnaire. Forty-nine new RWMA developed in nine patients during hemodialysis with dialysate at 37°C (HD 37 ), compared with thirteen RWMA that developed in four patients during HD 35 (odds ratio 3.8; 95% confidence interval 2.1 to 6.9). The majority of RWMA displayed improved function by 30 min after dialysis. Overall, regional systolic LV function was significantly more impaired during HD 37 (P < 0.001). BP was higher during HD 35 , with fewer episodes of hypotension as a result of a higher peripheral resistance and no difference in stroke volume. The development of thermal symptoms was heterogeneous, with most patients tolerating HD 35 well. This study confirms previous findings of reversible LV RWMA that develop during hemodialysis. It also shows that this phenomenon can be ameliorated by reducing dialysate temperature, a simple intervention with no cost implications.

show abstract

“…Intradialytic hypotension increases the risk of myocardial hypoperfusion, leading to segmental ischemia inducing segmental left ventricular (LV) dysfunction [8], a process known as myocardial stunning [9]. Myocardial stunning is cumulative and leads to irreversible LV dysfunction in ischemic heart disease [10,11]. …”

Section: Introductionmentioning

confidence: 99%

No Harmful Effect of Dialysis-Induced Hypotension on the Myocardium in Patients Who Have Normal Ejection Fraction and a Negative Exercise Test

Fotbolcu¹,

Oduncu

Gürel

et al. 2012

Kidney Blood Press Res

View full text Add to dashboard Cite

Background: We investigated the effects of dialysis-induced hypotension (DIH) on the myocardium of patients who have a normal ejection fraction and normal treadmill stress tests. Methods: This study included 26 end-stage renal disease (ESRD) patients with DIH, 30 ESRD patients without DIH (non-DIH), and 30 control subjects. Mitral-myocardial systolic velocity (MSV), the mitral E′/A′ ratio, the left ventricle filling pressure index (E/E′ ratio), tricuspid-MSV, and the tricuspid E′/A′ ratio were calculated. Results: Biventricular systolic and diastolic functions were impaired in dialysis patients. The mitral and tricuspid MSV were similar between DIH and non-DIH patients (8.03 ± 0.90 cm/s vs. 8.31 ± 1.68 cm/s, p = 0.896, and 13.27 ± 2.97 cm/s vs. 13.15 ± 2.37 cm/s, p = 0.980). Mitral and tricuspid E′/A′ were similar between DIH and non-DIH patients. (1.30 ± 0.53 vs. 1.16 ± 0.56, p = 0.695, and 0.70 ± 0.24 vs. 0.68 ± 0.33, p = 0.976). Likewise, the E/E′ ratio was similar between DIH and non-DIH patients (8.20 ± 2.83 vs. 8.28 ± 2.53, p = 0.990). Conclusion: Although biventricular systolic and diastolic function is impaired in dialysis patients compared to controls, DIH episodes did not have an adverse effect on the myocardial functions.

show abstract

Myocardial Alterations during Hemodialysis: Insights from New Noninvasive Technology

Cited by 38 publications

References 22 publications

Comparison of Myocardial Perfusion during Hemodialysis and Hemodiafiltration

Comparison of Myocardial Perfusion during Hemodialysis and Hemodiafiltration

Dialysis-Induced Regional Left Ventricular Dysfunction Is Ameliorated by Cooling the Dialysate

No Harmful Effect of Dialysis-Induced Hypotension on the Myocardium in Patients Who Have Normal Ejection Fraction and a Negative Exercise Test

Contact Info

Product

Resources

About