Diastolic dysfunction and intradialytic hypotension
Abstract
Aim. Intradialytic hypotension remains a frequent complication of dialysis. The aim of this study was to estimate the relationship between diastolic dysfunction and intradialytic hypotension in chronic hemodialysis patients. Methods. Twenty dialysis patients (11 M, 9 F, mean age 49 ± 12 years) who receive 4 hours bicarbonate HD 3 times a week were studied. Causes of chronic renal failure were chronic glomerulonephritis (n = 9), essential hypertension (n = 9) and diabetes mellitus (n = 2). Twelve patients had chronic heart failure. Seventeen patients had arterial hypertension. M-mode echocardiography was performed and left ventricular mass index (LVMI), ejection fraction (EF) were calculated. Transmitral flow was assessed by Doppler echocardiography. Peak velocity of early (E) and late (A) filling, E/A ratio, isovolumic relaxation time (IVRT) and early deceleration time (DT) were detected. All measures were performed one hour before and immediately after HD by one investigator. Results. Left ventricular hypertrophy was detected in 18 patients. EF was lower than 45% in 2 patients. Average amount of ultrafiltration was 1,9 ± 1,2 (range 0,2-4,2) l. There was significant positive correlation between weight loss and ∆E (r = 0,58; p = 0,01), and we didn’t detect correlation between ∆E and intradialytic hypotension. Patients with intradialytic hypotension had higher DT than patients without IDH (231,2 ± 65,3 vs 175,0 ± 51,0 ms, respectively, p = 0,04). Conclusion. Intradialytic hypotension is associated with left ventricular hypertrophy with significant increase of early deceleration time.
About the Authors
A. M. Shutov
Кафедра терапии и профессиональных болезней медицинского факультета Ульяновского государственного университета и Ульяновская областная клиническая больница
Russian Federation
Russian Federation
V. E. Mastykov
Кафедра терапии и профессиональных болезней медицинского факультета Ульяновского государственного университета и Ульяновская областная клиническая больница
Russian Federation
Russian Federation
O. M. Edigarova
Кафедра терапии и профессиональных болезней медицинского факультета Ульяновского государственного университета и Ульяновская областная клиническая больница
Russian Federation
Russian Federation
References
1. Денисов А.Ю., Новосельцев И.Л., Новосельцева Н.Л., Шило В.Ю. Профилактика синдиализной гипотензии у больных на программном гемодиализе методом профилирования натрия (NA) и ультрафильтрации (УФ). Нефрология и диализ (Тезисы) 2001; 2: 174.
2. Овчинников А.Г., Агеев Ф.Т., Мареев В.Ю. Методические аспекты применения допплерэхокардиографии в диагностике диастолической дисфункции левого желудочка. Сердечная недостаточность 2000; 2: 66-70.
3. Рекомендации по диагностике и лечению хронической сердечной недостаточности. Доклад экспертной группы по диагностике и лечению хронической сердечной недостаточности Европейского общества кардиологов. Сердечная недостаточность 2001; 6: 251-276.
4. Родин И.Н. Инструментальное определение «сухого веса» и оптимального объема ультрафильтрации у больных в условиях лечения программным гемодиализом. Нефрология и диализ 2002; 1: 41-44.
5. Сперанская С.М. Оптимизация диагностики начальных стадий диастолической сердечной недостаточности у больных гипертонической болезнью: Автореф. дисс. … канд. мед. наук. Саратов: 2002.
6. Шутов А.М., Куликова Е.С., Кондратьева Н.И. и др. Гипертрофия левого желудочка у больных в додиализном периоде хронической почечной недостаточности, не связанной с сахарным диабетом. Нефрология 2001; 2: 49-53.
7. Abergel E., Tase M., Bohlader J. Which definition for echocardiographic left ventricular hypertrophy? Am J Cardiol 1995; 75: 486-503.
8. Agarwal R. Supervised atenolol therapy in the management of hemodialysis hypertension. Kidney Int 1999; 55: 1528-1535.
9. Andrulli S., Colzani S., Marcia F. et al. The role of blood volume reduction in the genesis of intradialytic hypotension. Am J Kidney Dis 2002; 40: 1244-1254.
10. Begin V., Deziel C., Madone F. Biofeedback regulation of ultrafiltration and dialysate conductivity for the prevention of hypotension during hemodialysis. ASAIO J 2002; 48: 312-315.
11. Cai Y., Zimmerman A., Ladefoged S., Secher N.H. Can haemodialysis-induced hypotension be predicted? Nephron 2002; 92: 582-588.
12. Charra B. «Dry weight» in dialysis: the history of a concept. Nephrol Dial Transplant 1998; 13: 1882-1885.
13. Cheriex E.C., Leunissen K.M.L., Janssen J.H.A. et al. Echography of the inferior vena cava is a simple and reliable tool for estimation of «dry weight» in hemodialysis patients. Nephrol Dial Transplant 1989; 4: 563-568.
14. Coli L., La Manna G., Dalmastri V. et al. Evidence of profiled hemodialysis efficacy in the treatment of intradialytic hypotensison. Int J Artif Organs 1998; 21: 398-402.
15. Converse J.P.Jr., Jacobsen T.N., Jost C.M.T. et al. Paradoxical withdrawal of reflex vasoconstriction as a cause of hemodialysis-induced hypotension. J Clin Invest 1992; 90: 1657-1665.
16. Cruz O.N., Mahnensmith R.L., Brickel H.M., Perarella M.A. Midodrine and cool dialysate are effective therapies for symptomatic intradialytic hypotension. Am J Kidney Dis 1999; 33: 920-926.
17. Daugirdas J.T. Pathophysiology of dialysis hypotension: an update. Am J Kidney Dis 2001; 38 (Suppl 4): S11-S17.
18. Devereux R.B., Alomso D.R., Lutas E.M. et al. Echocardiographic assessment of left ventricular hypertrophy comparison to necropsy findings. Am J Cardio 1986; 57: 450-458.
19. Donauer J., Kolblin D., Bek M. et al. Ultrafiltration profiling and measurement of relative blood volume as strategies to reduce hemodialysis-related side effects. Am J Kidney Dis 2000; 36: 115-123.
20. European Study Group on Diastolic Heart Failure. How to diagnose diastolic heart failure. Eur Heart J 1998: 19; 990-1003.
21. Ganau A., Devereux R.B., Roman M.J. et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension J Am Coll Cardiol 1992; 19: 1550-1558.
22. Kim K.E., Neff M., Cohen B. et al. Blood volume changes and hypotension during hemodialysis. Trans Am Soc Artif Intern Organs 1970; 16: 508-514.
23. Krepel H.P., Nette R.W., Akcahuseyin E. et al. Variability of relative blood during haemodialysis. Nephrol Dial Transplant 2000; 15: 673-679.
24. Leypoldt J.K., Cheung A.K., Delmez J.A. et al. Relationship between volume status and pressure during chronic hemodialysis. Kidney Int 2002; 16: 266-275.
25. Movilli E., Camerini C., Viola B.F. et al. Blood volume changes during different profiles of dialysate sodium variation with similar intradialytic sodium balances in chronic hemodialyzed patients. A J Kidney Dis 1997; 30: 58-63.
26. Ozkahya M., Toz H., Qzerkan F. et al. Impact of blood control on left ventricular hypertrophy in dialysis patients. J Nephrol 2002; 15: 655-660.
27. Passauer J., Bussemaker E., Gross P. Dialysis hypotension: Do we see light at the end of the tunnel? Nephrol Dial Transplant 1998; 13: 3024-3029.
28. Punzengruber C., Wallner M. Doppler echocardiographic analysis of diastolic left ventricular function to intradialytic hypotension. Klin Wochenschr 1989; 67: 826-832.
29. Ritz E., Rambausek M., Mall G. et al. Cardiac changes in uraemia and their possible relationship to cardiovascular instability on dialysis. Nephrol Dial Transplant 1990; 5 (Suppl 1): 93-97.
30. Robinson T.G., Carr S.J. Cardiovascular autonomic dysfunction in uremia. Kidney Int 2002; 62: 1921-1932.
31. Rouby J.J., Rottembourg J., Durande J.P. et al. Importance of the plasma refilling rate in genesis of hypovolaemic hypotension during regular dialysis and controlled sequential ultrafiltration haemodialysis. Proc Eur Dial Transplant Assoc 1978; 14: 239-244.
32. Ruffmann K., Mandelbaum A., Bommer J. et al. Doppler echocardiographic findings in dialysis patients. Nephrol Dial Transplant 1990; 5: 426-431.
33. Sahn D.J., DeMaria A., Kissio J., Weyman A. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 1978; 58: 1072-1083.
34. Santoro A., Mancini E., Basile C. et al. Blood volume controlled hemodialysis in hypotension-prone patients: a randomized, multicenter controlled trial. Kidney Int 2002; 62: 1034-1045.
35. Schiller N.B., Shan P.M., Crawford M. et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. J Am Soc Echocardiogr 1989; 2: 358-367.
36. Schreiber M.J., Jr. Setting the stage. Am J Kidney Dis 2001; 38 (Suppl 4): S1-S10.
37. Schreiber M.J. Clinical case-based approach to understanding intradialytic hypotension. Am J Kidney Dis 2001; 38 (Suppl 4): S37-S47.
38. Schumacher J., Rob P., Kreft B. et al. Measurement of fluid volume shifts during hemodialysis by M-mode ultrasonography. Blood Purif 2000; 18: 103-109.
39. Takahashi H., Matsuo S., Toriyama T. et al. Autonomic dysfunction in hemodialysis patients with persistent hypotension. Nephron 1996; 72: 418-423.
40. Thomson G.E., Waterhouse K., McDonald H.P.J., Friedman E.A. Hemodialysis for chronic renal failure. Arch Intern Med 1967; 120: 153-167.
41. Traeger J., Gulland R., Arkouche W. et al. Short daily hemodialysis: A four-year experience. Dialysis &Transplantation 2001; 30: 76-86.
42. Zile M.R., Simsic J.M. Diastolic heart failure. Clin Cornerstone 2000; 3: 13-24.
Review
For citations:
Shutov A.M., Mastykov V.E., Edigarova O.M. Diastolic dysfunction and intradialytic hypotension. Nephrology and Dialysis. 2003;5(2):156-160. (In Russ.)
Views:
1
Email this article 