The effect of extracorporeal high blood flow rate on left ventricular function during hemodialysis—an echocardiography study

Abstract

Summary:The effect of increased extracopreal blood flow rate on left ventricular (LV) function has been studied during volume-controlled bicarbonate hemodialysis. Ten stable patients on chronic hemodialysis, with a mean age of 28 years (range 19-38) were studied using two-dimensional and Doppler echocardiography. The mean time on hemodialysis was 32 months (range 3-60). All patients were investigated during three dialysis sessions on the first day of the week for 3 consecutive weeks. The blood flow rate was chosen randomly as 250, 350, or 450 cc/min. Apart from the time of hemodialysis and blood flow rate, other parameters of the hemodialysis were kept stable during all three sessions. Echocadiographic studies were done before, at mid dialysis, and during the last 15 min of each dialysis session. The following parameters were evaluated: heart rate, mean blood pressure, shortening fraction, ejection fraction, cardiac output, and pre-ejection period/LV ejection time ratio. The changes of the measured cardiac parameters at the beginning, middle and end of each session were not significantly different. Furthermore, the differences in changes between the three different sessions were comparable. Our results indicate that an increase in dialysis blood flow rate up to 450 cc/min does not have an adverse effect on the left ventricle in patients on maintenance hernodialysis and with stable cardiovascular function.

Effect of increased blood flow rate on renal anemia and hepcidin concentration in hemodialysis patients

“…Despite the Japan DOPPS suggesting that a higher BFR may reduce the risk of death, Japanese dialysis clinical practitioners are concerned about the increased cardiovascular burden caused by an increase in BFR and thus ensured that the BFR levels were lower. However, with BFR at 400–500 mL/min, there was neither increase in blood flow access nor were there acute changes in cardiac function or blood pressure [ 16 , 17 ]. In fact, high-efficiency dialysis with a BFR greater than 450 mL/min did not increase the risk of death [ 18 ] and there was no increase in cardiac-related death in the high-dialysis group in the HEMO study in which a higher BFR was used [ 19 ].…”

JapaneseSociety forDialysisTherapyClinicalGuideline for “Maintenance Hemodialysis: Hemodialysis Prescriptions”

“…According to the JRDR analysis , a decrease in mortality rate with increasing Q B for up to 250–300 mL/min was suggested when 200 ≤ Q B < 220 mL/min was used as the reference. Although dialysis facilities in Japan are concerned about the increased load on the cardiovascular system with increasing Q B , an increase in blood flow of the vascular access or acute changes in cardiac function or blood pressure was not observed for 400 ≤ Q B < 500 mL/min . In fact, an increase in mortality rate was not observed for high‐efficiency dialysis performed even under Q B ≥ 400 mL/min .…”