Effects of Altered Volume Loading on Left Ventricular Hemodynamics and Diastolic Filling During Hemodialysis

Figures & data

Table 1. Baseline Characteristics of Study Subjects

Number	40
Age, y	52.7 ± 13.6
Male	18 (45.0%)
Etiology of chronic renal failure
Chronic glomerulonephritis	26 (65.0%)
Diabetes mellitus	8 (20.0%)
Systemic lupus erythematosus	3 (7.5%)
Polycystic kidney disease	1 (2.5%)
Renal cancer	1 (2.5%)
Bladder cancer	1 (2.5%)
Associated cardiovascular disease
Hypertension	25 (62.5%)
Coronary artery disease	2 (5.0%)
Heart failure	1 (2.5%)
Vasoactive medications
Beta‐blocker	6 (15.0%)
Alpha and beta‐blocker	7 (17.5%)
Calcium channel blocker	10 (25.0%)
Angiotensin II blocker	5 (12.5%)
Diuretics	4 (10.0%)
Nitrate	9 (22.5%)
Body height, cm	159.2 ± 7.0
Body weight, kg	59.2 ± 10.7
Body surface, m^2	1.61 ± 0.16

Table 2. Effects of Hemodialysis on Heart Size, Left Ventricular Volume and Mass

	Before	After	P
Aorta, mm	31.5 ± 3.7	30.4 ± 3.5	0.009
Left atrium, mm	37.6 ± 6.1	31.8 ± 5.8	< 0.001
LVOT, mm	20.3 ± 1.7	19.9 ± 1.5	0.018
Interventricular septum, mm	12.6 ± 3.0	11.8 ± 2.9	0.021
LVPW, mm	10.3 ± 1.9	10.1 ± 1.8	0.476
LVEDD, mm	48.3 ± 5.5	43.0 ± 5.9	< 0.001
LVESD, mm	28.8 ± 5.7	25.0 ± 6.6	< 0.001
FS,%	40.7 ± 7.8	42.5 ± 9.0	0.156
LVEDV, mL	111.0 ± 29.7	85.3 ± 28.4	< 0.001
LVESV, mL	33.6 ± 16.8	25.2 ± 17.5	< 0.001
LV mass, g	215.3 ± 66.7	171.0 ± 65.7	< 0.001
LV mass index, g/m^2	133.7 ± 39.5	107.7 ± 40.9	< 0.001

LVOT: left ventricular outflow tract; LVPW: left ventricular posterior wall; LVEDD: left ventricular end‐diastolic dimension; LVESD: left ventricular end‐systolic dimension; FS: fractional shortening; LVEDV: left ventricular end‐diastolic volume; LVESV: left ventricular end‐systolic volume; LV: left ventricular.

Table 3. Hemodynamic Changes Before and After Hemodialysis

	Before	After	P
Systolic BP, mm Hg	144.8 ± 31.7	123.7 ± 28.2	< 0.001
Diastolic BP, mm Hg	79.9 ± 11.3	71.7 ± 13.4	< 0.001
Heart rate, min^− 1	78.1 ± 11.5	83.4 ± 11.9	0.002
Body weight, kg	59.2 ± 10.7	56.6 ± 10.4	< 0.001
LVEF,%	72.7 ± 8.5	73.4 ± 9.5	0.335
Stroke volume, ml	73.7 ± 14.5	60.0 ± 13.9	< 0.001
Stroke volume index, mL/m^2	46.1 ± 9.4	38.2 ± 9.6	< 0.001
Cardiac output, L/min	5.74 ± 1.37	4.98 ± 1.27	< 0.001
Cardiac index, L/min/m^2	3.60 ± 0.96	3.19 ± 0.92	0.001
TPR, dyn.sec.cm^− 5	1497 ± 466	1513 ± 475	0.800

BP: blood pressure; LVEF: left ventricular ejection fraction; TPR: total peripheral resistance.

Table 4. Effects of Hemodialysis on Left Ventricular Diastolic Filling Parameters

	Before	After	P
E, cm/s	95.1 ± 20.5	70.3 ± 18.2	< 0.001
A, cm/s	104.3 ± 20.9	88.9 ± 16.9	< 0.001
E/A ratio	0.93 ± 0.21	0.80 ± 0.20	< 0.001
DT of E, ms	192.2 ± 50.0	212.9 ± 64.9	0.044
DTc of E, ms	217.0 ± 50.4	247.3 ± 69.3	0.011
IVRT	90.1 ± 23.9	106.6 ± 22.7	< 0.001
IVRTc	101.4 ± 23.4	124.7 ± 24.3	< 0.001
E dur, ms	244.9 ± 43.0	240.6 ± 59.2	0.627
E dur.c, ms	276.5 ± 38.7	280.1 ± 61.8	0.701
A dur, ms	151.8 ± 27.6	153.3 ± 22.9	0.805
A dur.c, ms	171.7 ± 29.2	179.9 ± 28.1	0.236
E dur/A dur ratio	1.66 ± 0.36	1.60 ± 0.43	0.486
E + A dur, ms	378.0 ± 97.9	355.6 ± 83.5	0.126
E + A dur.c, ms	422.7 ± 80.9	412.3 ± 74.1	0.409
EVTI, cm	13.90 ± 3.10	10.54 ± 3.56	< 0.001
AVTI, cm	9.25 ± 2.36	8.24 ± 1.75	0.003
EVTI/AVTI ratio	1.59 ± 0.54	1.32 ± 0.48	0.003

E: peak mitral inflow velocity at early diastole; A: peak mitral inflow velocity at late diastole; DT: deceleration time; DTc: correction of DT; IVRT: isovolumic relaxation time; IVRTc: correction of isovolumic relaxation time; E dur: duration of E; E dur.c: correction of E duration; A dur: duration of A; A dur.c: correction of A duration; E + A dur: total duration of E and A; E + A dur.c: correction of total duration of E and A; E_VTI: velocity‐time integral of E; A_VTI: velocity‐time integral of A.