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e-Journal of Science & Technology, (e-JST)



Arterial pressure changes on cardiac function during hemodialysis

 Dimitrios I. Chaniotis*,  Evangelos Papademitriou, Stavroula Galani-Triantaphyllidou, Petros Petropoulos, Frangiskos  Chaniotis

 Technological Educational Institution (TEI) of Athens and Ioannina

Foundation of Biomedical Research, Cardiovascular Division, Academy of Athens

*(Address for correspondence: Tel. +6973049444, e-mail: haniotisdimitris@gmail.com



 Left ventricular (LV) diastolic function has been causally deteriorated on hypotensive episodes during hemodialysis (D). The influence of intravascular volume deterioration and arterial pressure reduction on LV function in patients without hypotensive episodes during D has not been adequately studied. 23 patients on D were studied for 4835 months, whose mean age was 5012 years, their mean body mass index was 244kg/m2 and their mean fluid retention between D sessions 2.21.1 kgr. We used 2D and Doppler echocardiography before and after the same HD session. The following parameters were measured: a) end-diastolic (LVED) and end-systolic LV diameters, left atrial diameter (LA) and fraction shortening (FS) b) isovolumic relaxation (IVRT) and contraction (ICT) time, deceleration time (DT), and waves of the mitral inflow and ejection time () of the LV outflow velocity. The following indices were calculated: E/A ratio, myocardial performance index () using the (IVRT+ICT)/ET formula, mean arterial pressure (), the % reduction in and the reduction in intravascular volume after HD. Stroke volume (SV) and corresponding cardiac output (CO), were calculated from the LV outflow velocity waveform. All patients demonstrated systolic arterial pressure at the level of 90mmHg and normal FS before D, while they had demonstrated restrictive LV diastolic filling before D. , SV, CO, LVD, L, wave and / decreased while IVRT increased after D (p<0.01). After HD, low values (normal range <0.44) were related to greater ultrafiltration volume loss (UFV) (r=0.53, p<0.01) and greater % reduction in (r=0.62, p<0.01). Conversely, abnormal values were related to high after D (r=0,44, p<0.01). Increased UFV was related to greater % increase in IVRT (r=0.43, p<0.01) and % decrease in / (r=0.40, p<0.01) after HD. Patients with UFV >3kg (7/23) had lower (0.470.2 vs. 0.840.3, p<0.01) and greater % increase in VRT and % reduction in / (p<0.01 ) than those with <3kgr. Fluid retention between D sessions leads to restrictive LV diastolic filling as shown by an />1 and a short IVRT in patients before HD. Reduction in the excess intravascular volume after D normalises and thus, improves LV performance.

Key words: Echocardiography assessment, Cardiac function, Heart rate, Arterial pressure, Intravascular volume, Ultrafiltration volume, Chronic renal failure, Hemodialysis.