Cardiovascular disease in patients on chronic hemodialytic therapy

Scharf, Stephen C.; Wexler, John; Longnecker, Robert E.; Blaufox, M. Donald

doi:10.1016/0033-0620(80)90027-4

Cited by 39 publications

(12 citation statements)

References 65 publications

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“…Nevertheless the potential causes of impaired contractility during the peritransplant period include chronic hypertension [20], hemodialysis, iron overload [21] and volume overload injury [22], The peak late transmitral velocity reduc tion and the slight increase in the E/A ratio we observed may reflect an improvement in LV relaxation [23] in patients with lower BP at follow-up. We hypothesize that peak late transmitral velocity reduction could be an early marker of diastolic function improve ment after RT.…”

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confidence: 85%

Changes in Left Ventricular Mass and Filling after Renal Transplantation Are Related to Changes in Blood Pressure: An Echocardiographic and Pulsed Doppler Study

Peteiro¹,

Alvarez²,

Calviño³

et al. 1994

Cardiology

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To examine changes in left ventricular (LV) mass and function (diastolic and systolic) after successful renal allograft transplantation (RT), we prospectively studied 30 patients (19 men, 11 women, aged 37 ± 13 years) by M-mode, two-dimensional and pulsed Doppler echocardiography at the time of surgery and 10 ± 1.8 months later. At the time of transplantation all patients had been undergoing dialysis (4 peritoneal dialysis, 26 hemodialysis) for 2.5 ± 3.2 years. A hematocrit of ≤30% was present in 26 patients. After RT the mean hematocrit increased from 26 ± 4 to 40 ± 7 (p < 0.01), whereas systolic, diastolic and mean blood pressure (BP) remained unchanged. The LV mass index (LVMI) decreased from 201 ± 56 to 171 ± 41 g/m², (p < 0.01); LV diastolic diameter corrected by body surface area (LVDDI) decreased from 298 ± 38 to 279 ± 35 (p < 0.01) and the LV end-diastolic volume index (LVEDVI) from 72 ± 18 to 63 ± 15 (p < 0.01). There were no changes in LV fractional shortening or LV end systolic wall stress. Peak late transmitral velocity (A wave) decreased from 77 ± 16 to 68 ± 12 cm/s (p < 0.01) with no changes in other Doppler-derived indexes of diastolic function. No fistula patency influence on changes in LV mass and function was found. After RT, BP decreased in 21 patients from 150 ± 20 to 132 ± 15 (p < 0.001; group I) and increased in 9 patients from 130 ± 14 to 153 ± 16 (p < 0.05, group II). Patients in group I suffered a reduction in LVMI (p < 0.001), LV end-diastolic diameter (p < 0.05), LVDDI (p < 0.001); LV end-diastolic volume (p < 0.05); LVEDVI (p < 0.01); cardiac index (p < 0.05), and peak late transmitral velocity (p < 0.01), but no changes in group-II patients were observed. We concluded that BP is a major determining factor with regard to changes in LV hypertrophy and function following RT. LV mass and volumes can be expected to decrease after RT in patients with BP reduction.

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confidence: 85%

Changes in Left Ventricular Mass and Filling after Renal Transplantation Are Related to Changes in Blood Pressure: An Echocardiographic and Pulsed Doppler Study

Peteiro¹,

Alvarez²,

Calviño³

et al. 1994

Cardiology

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“…Although oximetry was not carried out in our patient population, other studies suggest that HD can provoke significant tissue hypoxemia [24,25], This would be a possible mechanism whereby a myocardial oxygen supply deficit could occur. Other possi ble mechanisms include hypoventilation, anemia, coro nary vasospasm, or enhanced platelet activation [26,27], Although this is the first study to look at EF during HD, at least one study has looked at EF before and after HD using radionuclide scintigraphic techniques [28]. In this study, patients with normal hearts had a mean improvement in EF of 12.9 ± 4.4%, while those with heart disease had a mean decrease in EF of 2.3 ± 8.1%.…”

Section: Discussionmentioning

confidence: 99%

Myocardial Alterations during Hemodialysis: Insights from New Noninvasive Technology

Singh¹,

Langer²,

Freeman³

et al. 1994

Am J Nephrol

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Eighteen patients with chronic renal failure had their cardiac status monitored during hemodialysis (HD). Ten studies were carried out using an ambulatory nuclear vest to assess ejection fraction (EF), heart rate (HR), relative end-systolic (ESV) and end-diastolic (EDV) volumes every 60 s. A total of 36 episodes of EF falls occurred in 9 patients, all asymptomatic. These EF falls were associated with a rise in ESV, while HR, BP, and EDV remained unchanged. The EF falls correlated best with the volume of ultrafiltrate removed. Ten patients had on-line ST-segment monitoring with sestamibi injection either at the time of ST depression (STD) or at the end of dialysis, if no STD occurred, in order to detect the presence of transient ischemia. Seven often patients had perfusion defects after dialysis, with STD occurring in 3 of 10 patients. Pre-dialysis imaging was available in only 8 of 10 patients, and 6 of these patients had perfusion defects. Changes in perfusion defects were not significantly different in the 3 patients with STD compared with those without STD. EF falls and perfusion defects are common in HD patients even in the absence of known coronary artery disease; however, ST segment monitoring is not a sensitive tool for its detection. These changes in function and perfusion may represent myocardial ischemia and contribute to the high incidence of cardiovascular morbidity and mortality in this patient population.

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“…Cardiac failure is common in patients with end-stage renal disease (ESRD) [2]. In addition to direct myocardial depression from a circulating toxin associated with uremia, chronic renal failure has the potential to cause myocardial dysfunction through chronic hypertension [3], premature atherosclerosis due to abnormal carbohydrate and lipid metabolism [4], cardiomyopathy associated with iron overload [5] and volume overload injury due to chronic anemia, hypervolemia, and iatrogenic arteriovenous fistulas [6,7]. …”

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

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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.

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Cardiovascular disease in patients on chronic hemodialytic therapy

Cited by 39 publications

References 65 publications

Changes in Left Ventricular Mass and Filling after Renal Transplantation Are Related to Changes in Blood Pressure: An Echocardiographic and Pulsed Doppler Study

Changes in Left Ventricular Mass and Filling after Renal Transplantation Are Related to Changes in Blood Pressure: An Echocardiographic and Pulsed Doppler Study

Myocardial Alterations during Hemodialysis: Insights from New Noninvasive Technology

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

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