Right Ventricular Functionality Following Hemodialysis Initiation in End-Stage Kidney Disease—A Single-Center, Prospective, Cohort Study

Abstract

Background and Objectives: Two-dimensional speckle tracking echocardiography (2D-STE) is viewed as an outstanding technique, competent of uncovering earlier subclinical myocardial anomalies compared to conventional echocardiography. A few endeavors adopted 2D-STE as a tool to estimate right ventricular (RV) function in subjects with end-stage kidney disease (ESKD). There is no published prospective study on an adult ESKD cohort exploring the consequences of commencing elective hemodialysis (HD) on RV behavior. Materials and Methods: We investigated the RV systolic function using traditional (tricuspid annular plane systolic excursion—TAPSE, RV fractional area change—FAC) and 2D-STE (RV free wall longitudinal strain—RVFWLS) parameters following the initiation of HD. We enrolled 79 consecutive patients with ESKD and assessed them in four steps—at baseline, before HD, and at 3, 6, and 12 months. Results: RVFWLS, FAC, and TAPSE values had a significant increase at 3, 6, and 12 months from baseline (p < 0.001) and a significant increase at 6 months from 3 months (p < 0.001). However, differences between 12 months and 6 months were not significant (p > 0.05) according to Dunn–Bonferroni post hoc tests. Seventeen deaths were recorded before the completion of the study. RVFWLS, FAC, and TAPSE values significantly decreased at 3 and 6 months in all 17 deceased patients, in clear opposition with the values survivors had. All the studied parameters had a significant prediction power on mortality (p < 0.001) having an outstanding performance: baseline-RVFWLS (AUC: 1.000 (95% C.I.: 1.000–1.000)), baseline-FAC (AUC: 0.974 (95% C.I.: 0.942–1.000)), and baseline-TAPSE (AUC: 0.962 (95% C.I.: 0.920–1.000). Conclusions: Our study is the first to investigate RV function by 2D-STE and correlate it with traditional methods in patients with ESKD before and after the initiation of HD. RV function was significantly ameliorated at 3, 6, and 12 months compared to the pre-HD values. FAC and RVFWLS gain an outstanding prognostic role on mortality in this population.

Treatment with Sacubitril/Valsartan Effectively Manages Hypertension and Ameliorates Left Ventricular Hypertrophy in Hemodialysis Patients

“…Notably, the systolic function of the right ventricle demonstrates a significant decline during the progression of CKD, likely influenced by volume status. It has been observed that RV ejection fraction improves during the initial phase of hemodialysis [27][28][29]. TRPG serves as an indicator of afterload on the right ventricle, and reducing TRPG levels has been associated with improved cardiovascular prognosis [30].…”

Right Ventricular Function Assessment by Speckle Trackingechocardiography in Patients on Regular Hemodialysis With Preserved Left Ventricular Ejection Fraction

“…Tasana in 2021 suggested that a low value of RV strain carries the burden of mortality in hemodialysis patients, independent of any other aggravating or ameliorating factor [10].…”

Przebudowa serca oraz funkcja prawej komory u pacjentów ze schyłkową niewydolnością nerek rok po włączeniu hemodializoterapii

“…There are studies assessing short term changes of RV parameters e.g. TAPSE, S', FAC, MPI, before and after a single HD procedure, that show improvement of RV function associated with preload reduction [13].…”