Changes of the Cardiac Architectures and Functions for Chronic Hemodialysis Patients with Dry Weight Determined by Echocardiography

Abstract

Background/Aims: Left ventricular hypertrophy (LVH) has long been known as an independent risk factor for cardiovascular deaths, in both dialysis and general populations. Numerous factors influence the pathophysiology of LVH. However, extracellular fluid may have a particularly important influence on this impact. Inferior vena cava diameter (IVCD) estimation is a non-invasive and relatively convenient method for obtaining a good correlation with the intravascular fluid status, and may obtain an optimal dry weight (DW) for chronic hemodialysis patients. This study estimates the DW of end-stage renal disease (ESRD) patients by echocardiographic measurement of the IVCD to observe changes in cardiac morphology and function. Methods: A total of 88 patients, ranging from 26 to 90 (59.4 ± 13.3) years of age, were involved in this study. The patients were divided into study (n = 48) and control (n = 40) groups. All patients received IVCD assessment via echocardiography bi- monthly for 1 year. In the study group patients, DW was adjusted according to the IVCD by echocardiography. Meanwhile, in the control group patients, DW was adjusted based on traditional clinical parameters. All patients underwent cardiac examinations and measurements, including left ventricular mass (LVM), wall thickness, chamber size and left ventricular systolic function by echocardiography, at the beginning and end of the study. Results: Both groups displayed comparable clinical and biochemical parameters. The IVCD index correlated well with the cardiac parameters estimated by echocardiography. The LVM and left ventricular mass index (LVMI) was reduced significantly in the study group patients (from 200 ± 64.2 to 187 ± 63.2 g, p = 0.021; from 132 ± 37.6 to 123 ± 37.3 g/m², p = 0.014, respectively). Furthermore, the study group patients with fluid overload, named study subgroup A, displayed significant differences not only in LVM and LVMI, but also in septal wall thickness, left ventricular end-diastolic dimension and left atrial dimension. In contrast, the control group displayed no changes in these cardiac architectures during the study period. Conclusion: Adjusting DW via the IVCD measured by echocardiography for hemodialysis patients may prevent the progression of chamber dilatation and LVH, especially for patients with fluid overload.

Pulmonary Dysfunction Is Possibly a Marker of Malnutrition and Inflammation but Not Mortality in Patients with End-Stage Renal Disease

“…Intima-media thickness in high-hsCRP and malnourished patients was greater than that in low-hsCRP and normal nutrition patients (p = 0.062 and p < 0.0001, respectively). Increased LVM and LVMI have long been recognized to be independent risk factors for cardiovascular death in both dialysis patients and the general population [26]. Chronic inflammation as diagnosed by increased levels of CRP, malnutrition and hyperparathyroidism have also been identified as important risk factors for cardiovascular disease in hemodialysis patients as well as the general population [27].…”

Handcarried Ultrasound Measurement of the Inferior Vena Cava for Assessment of Intravascular Volume Status in the Outpatient Hemodialysis Clinic

“…The accuracy of volume assessment by dry weight was determined through a comparison with established VCDi and IVCCI cutoffs (Table 1) (18,22,23). Patients were considered to be at goal weight when they were within 0.5 kg of their preestablished dry weight.…”

“…One of the most promising techniques for monitoring intravascular volume involves ultrasound assessment of the indexed inferior vena cava diameter (VCDi) and collapsibility index (IVCCI), which have been shown to be accurate measures of right atrial pressure and volume status in HD patients (18 -21). Titration of dry weights to a VCDi between 8.0 and 11.5 mm/m 2 (correlating with a right atrial pressure of 3 to 7 mmHg) significantly decreases intradialysis adverse events, left ventricular mass, and left atrial size as well as improves quality of life (22)(23)(24). However, barriers to the widespread implementation of an echocardiographic method in outpatient dialysis clinics include the cost and availability of conventional ultrasound machines, as well as the specialized training that is necessary for operation of these platforms.…”

Caval Aorta Index and Central Venous Pressure Correlation in Assessing Fluid Status! “Ultrasound Bridging the Gap”

“…In 1979, Natori et al [8] proved good correlation between the changes in IVC diameter and right atrial blood pressure. Studies are conducted on the usefulness of sonographic IVC diameter assessment in monitoring body fluid status in patients undergoing hemodialysis [6,9,10], patients with nephritic syndrome [11], or those hospitalized in ICU.…”