Tsilonis K, Sarafidis PA, Kamperidis V, Loutradis C, Georgianos PI, Imprialos K, Ziakas A, Sianos G, Nikolaidis P, Lasaridis AN, Karvounis H. Echocardiographic Parameters During Long and Short Interdialytic Intervals in Hemodialysis Patients.
Am J Kidney Dis 2016;
68:772-781. [PMID:
27545351 DOI:
10.1053/j.ajkd.2016.06.017]
[Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 06/06/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND
The long interdialytic interval in thrice-weekly hemodialysis is associated with excess cardiovascular risk. However, the mechanisms behind these adverse consequences are not fully understood. This study investigated the interdialytic changes in right and left ventricular function during the 2- and 3-day intervals.
STUDY DESIGN
Observational study with 2 random crossover sequences of recordings: 3-day followed by 2-day interval or vice versa.
SETTINGS & PARTICIPANTS
41 stable patients with end-stage renal disease on standard thrice-weekly hemodialysis therapy.
PREDICTOR
3-day (long) versus 2-day (short) interdialytic interval.
OUTCOME
Interdialytic change in echocardiographic indexes of left and right ventricular function.
MEASUREMENTS
2-dimensional echocardiographic and tissue Doppler imaging studies were performed with a Vivid 7 cardiac ultrasound system at the start and end of the 3- and 2-day interdialytic intervals.
RESULTS
During both intervals studied, elevations in cardiac output, stroke volume, left ventricular mass index, and peak early diastolic velocities of the left ventricle were evident. Interdialytic weight gain (3.0±1.7 vs 2.4±1.3 [SD] kg) and inferior vena cava diameter increase (0.54±0.3 vs 0.25±0.3) were higher during the 3-day versus the 2-day interval (P<0.001). Left ventricular systolic and diastolic function indexes were generally no different between interdialytic intervals. In contrast, interdialytic increases in left and right atrial volume, right ventricular systolic pressure (RVSP; 15.3±10.2 vs 4.7±5.2mmHg; P<0.001), and tricuspid regurgitation maximum velocity (0.46±0.45 vs 0.14±0.33m/s; P=0.001) were significantly greater during the 3- versus the 2-day interval. Multivariable analysis suggested that changes in interdialytic weight gain, right ventricle diastolic function, and pulmonary vascular resistance were determinants of the change in RVSP.
LIMITATIONS
Observational study design.
CONCLUSIONS
Excess volume accumulation over the long interdialytic interval in hemodialysis patients results in higher left and right atrial enlargement and RVSP elevation, which clinically corresponds to pulmonary circulation overload, providing one plausible pathway for the excess mortality risk during this period.
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