Echocardiographic changes following hemodialysis initiation in patients with advanced chronic kidney disease and symptomatic heart failure with reduced ejection fraction

Abstract

Background: In patients without overt cardiac disease, the degree of left ventricular hypertrophy (LVH) gets worse following hemodialysis (HD) initiation; however, in patients with both advanced chronic kidney disease (CKD) and symptomatic heart failure (HF) with reduced ejection fraction (EF), the short-term effect of HD on LVH and LV geometry has not been examined. We hypothesized that left ventricular mass index (LVMI) would decrease following HD initiation in CKD patients with symptomatic HF. Methods: We retrospectively evaluated changes in LVMI, LV geometry, and LV fractional shortening (LVFS), assessed by 2D transthoracic echocardiography (TTE), in 41 patients with HF initiating HD while hospitalized from 1995 to 2006. HF was defined by LVEF ≤ 45% or dyspnea plus two of the following: raised jugular venous pressure, bibasilar crackles, pulmonary venous hypertension, interstitial edema on chest X-ray, or both. TTE was performed within 3 months prior to first HD and repeated 8.6 ± 5.2 months after start of HD. TTE recordings were obtained from storage and analyzed by a cardiologist blinded to patient clinical characteristics. Results: Before initiation of HD, LVMI in 39 patients was 167.9 ± 53.1 g/m 2 and it decreased by -24.3 ± 35.4 g/m 2 by follow-up, p < 0.001. 26% of patients with concentric LVH at baseline had concentric remodeling or eccentric LVH at follow-up. LVFS did not significantly change over time in all 41 patients with HF (25.7 ± 8.7% vs. 26.4 ± 8.7%, p = 0.66). However, in an expanded analysis of all 69 patients with serial TTEs, a 1% increase in LVFS after starting HD was associated with a 16% reduction in risk of cardiovascular hospitalization at follow-up (HR 0.84, 95% CI 0.73 -0.96, p = 0.01). Conclusions: LVMI decreases following HD initiation in CKD patients with symptomatic HF and reduced LVEF, possibly due to relief of venous congestion. Increase in LVFS following HD initiation predicts improved cardiac outcome.

Heart Failure in Patients with Chronic Kidney Disease: A Systematic Integrative Review

“…In patients with ESRD and HF, the initiation of dialysis may have favorable effects on the heart structure, possibly due to decrease of fluid overload. In a recent retrospective echocardiographic study of 41 patients with advanced CKD and symptomatic HF with low LVEF, Ganda et al [170] found a significant reduction in LV mass index within a few months from the start of HD, although there was no change in LV shortening fraction.…”

Evaluation of echocardiographic variables in patients of chronic renal failure: pre and post hemodialysis-a single center prospective study

“…Similarly, an increase in serum ionized calcium and reduction in acidemia after hemodialysis would be expected to exert positive ionotropic effect on heart. 15 LV fractional shortening (FS) also increased in study patients following hemodialysis but it was not statistically significant. A study done by Nixon et al had showed that these changes in left ventricular function produced by regular hemodialysis are the combined effects of decrease in end diastolic volume and increase in contractile state of left ventricle.…”

Cardiovascular Parameters in Chronic Haemodialysis Patients in Tobago

“…Diabetic autonomic neuropathy and hypertensive heart disease are also contributing factors (6). Fluid overload contributes to venous congestion (7). Long-term haemodialysis via arteriovenous access may be involved in the pathogenesis of pulmonary hypertension by affecting pulmonary vascular resistance and cardiac output (8).…”