The Ebb and Flow of Echocardiographic Cardiac Function Parameters in Relationship to Hemodialysis Treatment in Patients with ESRD

Abstract

Cardiovascular disease is the leading cause of mortality in patients receiving hemodialysis. Cardiovascular events in these patients demonstrate a day-of-week pattern; they occur more commonly during the last day of the long interdialytic interval and the first session of the week. The hemodialysis process causes acute decreases in cardiac chamber size and pulmonary circulation loading and acute diastolic dysfunction, possibly through myocardial stunning and other non-myocardial-related mechanisms; systolic function, in contrast, is largely unchanged. During interdialytic intervals volume overload, acid-base, and electrolyte shifts, as well as arterial and myocardial wall changes, result in dilatation of right cardiac chambers and pulmonary circulation overload. Recent studies suggest that these alterations are more extended during the long interdialytic interval or the first dialysis session of the week and are associated with excess volume overload or removal, respectively, thus adding a mechanism for the day-of-week pattern of mortality in patients receiving hemodialysis. This review summarizes the existing data from echocardiographic studies of cardiac morphology and function during the hemodialysis session, as well as during the interdialytic intervals.

The effects of intradialytic exercise on hemodialysis adequacy: A systematic review

“…Finally, the exercise response in this population needs to be fully understood to provide effective exercise prescription. For example, hemodialysis patients have impaired cardiac function, vascular endothelial dysfunction, and altered autonomic function, all of which may blunt the blood flow response to exercise. This may potentially explain why a fair proportion of the findings observed in the reported studies do not replicate simulated mathematical models based on exercise hyperemia.…”

“…Finally, the exercise response in this population needs to be fully understood to provide effective exercise prescription. For example, hemodialysis patients have impaired cardiac function, 36 vascular endothelial dysfunction, 37 and altered autonomic function, 38 16,21,26 As opposed to phosphate, dialytic potassium clearance is typically efficient and therefore its removal poses less of a clinical challenge.…”

Cardiovascular Functional Changes in Chronic Kidney Disease: Integrative Physiology, Pathophysiology and Applications of Cardiopulmonary Exercise Testing

“…These results suggest important mechanistic differences leading to reduced cardiovascular function in advanced CKD as opposed to those in hypertensive cardiovascular disease alone. The finding that LV ejection was not predictive of VO 2 Peak is not surprising, given that the majority of CKD patients with heart failure have diastolic rather than systolic dysfunction (Loutradis et al, 2018). It is possible that increased LV diastolic stiffness may in part contribute to impaired cardiovascular functional capacity as CKD progresses; further studies are required to elucidate this.…”

“…Importantly, in heart failure patients with reduced ejection fraction on beta-blockers, VO 2 Peak retains its prognostic significance ( O’Neill et al, 2005 ), and is an important predictor of mortality in heart failure with preserved ejection fraction ( Haykowsky et al, 2011 ; Dhakal et al, 2015 ). This latter finding is particularly relevant to the renal population given that there is a disproportionate increase in heart failure with preserved ejection compared with reduced ejection fraction in CKD patients ( Loutradis et al, 2018 ). In addition to heart failure, VO 2 Peak has also been shown to be a predictor of survival in chronic lung disease ( Nixon et al, 1992 ; Gitt et al, 2002 ; Oga et al, 2003 ; Arena and Sietsema, 2011 ) and perioperative risk with major surgery ( Older et al, 1999 ; Wilson et al, 2010 ; Ting et al, 2013 ).…”

Cardiac Imaging in Dialysis Patients

“… 10 Additionally, due to the ease with which echocardiography can be performed, it can provide valuable information across various clinical situations. 28 …”