Cardiodynamic Studies of Uremics Before and After Dialysis

Abstract

In 12 uremic patients, simultaneous records of the ballistocardiogram and the carotid pulse derivative were taken before and after 36 dialyses. The ECG was also taken in many cases. In the great majority of instances cardiac function remained normal or was unchanged by the dialyses. In a few cases it was definitely improved. However, in 8 instances the heart became weak and (or) incoordinate after dialysis, and in a few patients the abnormality was very striking. These adverse changes in cardiac function took place despite improvement in the blood levels of potassium and other electrolytes. Fortunately, our cases soon recovered from the cardiac damage. We must emphasize the interesting negative aspects of our results. The changes in plasma potassium encountered in our studies are among the largest to be found in the clinic, but they were not accompanied by consistent changes in the circulation. Repeatedly, great improvement in plasma potassium levels was not accompanied by any dynamic change in cardiac function detectable by our methods. Nor did the ECG change consistently. So the expectations generated by classic physiological experiments that abnormal levels of potassium have a deleterious effect on the circulation has no support from our results, probably because the situation of our patients, who had suffered from abnormal blood levels of electrolytes for months or years, was so very different from that in the acute experiments of the physiologists.

Electrocardiographic Changes following Dialysis

“…Henderson and co-workers [12,13] found the QT interval changed more frequently than any other valuable, but cardiograms consistent with anterior wall ischemia occurred after three dialyses and lateral wall ischemia in another. However, there were only 12 patients who underwent 36 dialyses, and it is not recorded if the ischemia occurred on successive dialyses in the same patient and thereby falsely skewed their data.…”

“…, and R wave alterations [6,7], Changes in the T wave configuration have been correlated to the serum potassium during dialysis [8,9], However, there is a paucity of data on the relative occurrence of cardiographie changes indicating ischemia. The available studies deal with small patient populations or with artificial kidneys that are not presently being used [10][11][12][13], Since these studies were completed, the dialysis population has grown in size, age, and variety of diseases. The evaluation of possible ischemic EKG changes occurring with dialysis is of importance because of the recognized vascular compli cations and the potential for extracorporeal circulation and ultrafiltration to adversely affect the compromised patient.…”

Hemodynamic Changes during Hemodialysis

“…Although hemodynamic changes associated with hemodialysis in pa tients with chronic renal failure have already been reported by Del G reco et al [6], Hampers et al [10], and others [5,11,22], most previous investigations have been confined to comparisons of the status before and after hemodialysis. In this study, the accent was placed on hemodynamic alterations during hemodialysis as induced by increasing the extracor poreal blood flow rate in a stepwise fashion from 100 to 400 ml/min.…”

Cardiac effects of chronic renal failure and haemodialysis treatment. Hypertensive versus normotensive patients.

“…Cardiac output is increased because of the increased oxygen demand of the tissues, because of chronic anaemia, and chronic volume overload.' An arteriovenous fistula for haemodialysis treatmnent also augments cardiac output, decreasing the peripheral vascular resistance.1-5 Arterial hypertension also causes cardiac changes, which are the most important factors affecting the patients' prognosis.6 Uraemic changes in metabolism and electrolyte balance may affect the heart leading to uraemic pericarditis' [7][8][9][10][11] and, perhaps, to uraemic cardio-Received for publication 23 December 1980 710 myopathy.' 12 13 Hence an entirely normal heart in chronic renal failure is an exception rather than the rule, and the diseased heart is quite easily affected by the haemodynamic alterations caused by haemodialysis.…”