Doppler Echocardiographic Findings in Dialysis Patients

Abstract

We used Doppler echocardiographic techniques firstly to examine left ventricular (LV) filling patterns in dialysis patients, secondly to analyse whether Doppler echocardiographic left ventricular filling pattern is different in patients with recurrent intradialytic hypotension, and thirdly to study the relation between blood pressure decrease during volume subtraction and left ventricular filling pattern. Indices of left ventricular filling patterns of 47 dialysis patients were consistently different when compared to normotensive healthy controls. To further assess the relation of left ventricular filling pattern to blood pressure stability on dialysis, we first compared 24 patients with stable intradialytic blood pressure (BP) and 23 patients with one or more episodes or intradialytic hypotension per month. Patients with recurrent intradialytic hypotension had lower predialysis blood pressure (MAP 89 +/- 13 vs 96 +/- 14 mmHg), more severe concentric hypertrophy (left ventricular mass/volume ratio 2.7 +/- 1.4 vs 2.0 +/- 0.7), and impaired left ventricular filling (Doppler) as indicated by the ratio of early diastolic vs late (atrial) filling (0.66 +/- 0.2 vs 0.95 +/- 0.22). Subsequently we assessed by Doppler technique the effect of a predetermined rate of volume subtraction (during one dialysis session) in patients with or without recurrent intradialytic hypotension. Diastolic filling indices deteriorated consistently prior to the reduction in blood pressure (early diastolic filling 26.8 +/- 15.2 vs 45.4 +/- 10.9% of diastolic filling). It is suggested that impaired left ventricular filling, presumably reflecting disturbed left ventricular compliance, is common in dialysis patients. Findings by noninvasive Doppler techniques suggest a role of abnormal left ventricular distensibility in recurrent dialysis hypotension.

Left Ventricular Diastolic Function in a Predialysis Patient Population

“…2 Diastolic dysfunction and the LV mass/ volume ratio are associated with a greater incidence of intradialytic hypotension. 18,19 Studies have also related LV diastolic dysfunction to higher perioperative mortality from pulmonary oedema at the time of renal transplantation. 2 These patients therefore run a higher risk of sudden death especially during dialysis because of the changes in fluid balance.…”

Non-Occlusive Mesenteric Ischemia in Chronically Dialyzed Patients: A Disease with Multiple Risk Factors

“…Left ventricular hypertrophy may contribute to hypotension during dialysis and, as stated previously, this probably initiates the process leading to mesenteric ischemia [30]. …”

Bioimpedance for assessing volume status in children with nephrotic syndrome

“…As such, the usage of these biomarkers is restricted, but echocardiography and the inferior vena cava collapsibility index (IVCCI) and inferior vena cava index (IVCI) are commonly used to determine intravascular volume, especially for hemodialysis patients (8)(9)(10). It is difficult to perform these techniques with pediatric patients as these measures often vary depending on the individual performing the test, and sometimes these tests do not accurately indicate the severity of the volume loss, which greatly reduces the utility of these methods (11,12).…”