Cardiac Evaluation and its Correlation with Volume Status in Maintenance Hemodialysis Patients

Abstract

Introduction: Fluid overload (FO) in hemodialysis (HD) patients can result in increase in left atrial volume (LAV) and left ventricular mass (LVM). Here, we correlated volume status with cardiac outcome in these patients over a period of 6 months. Methodology: Consecutive clinically euvolumic end stage renal disease (ESRD) patients on thrice weekly maintenance hemodialysis (MHD) for at least 6 months were included. Inferior vena cava (IVC) Collapsibility Index of ≤40% by IVC or B-Line score of ≥15 by lung ultrasound (LUS) or over hydration/extracellular water (OH/ECW) by bioimpedence spectroscopy (BIS) ≥15% were defined as FO. A cut-off of left ventricular mass index (LVMI) ≥115 gm/m2 and LAV index (LAVI) ≥34 mL/m2 on echocardiography were used for defining left ventricular hypertrophy (LVH) and left atrial dilatation (LAD), respectively. The diagnostic value of LUS for OH, considering BIS as the gold standard and correlation between LVMI and LAVI with OH/ECW and LUS score was studied. Results: Among 100 MHD patients, 29% had OH at baseline. Baseline FO was significantly associated with LAD but not LVH. The specificity of LUS in diagnosing FO at 3rd and 6th months was 98% and 95.1%, respectively. OH/ECW on BIS showed a correlation with both LAVI at baseline ( p-value of .03, R2 0.71). B line score determined by LUS did not show a correlation with LAVI at baseline ( p-value of .07, R2 0.49). Conclusion: Routine ultrasound use in HD unit for determining OH and echocardiography screening for LAD would assess and reduce early cardiovascular events.