Abstract 11164: Dialysis-Related Symptoms are Associated with Deterioration of Cardiac Function During Dialysis
Background: Individuals with end-stage renal disease on dialysis have an increased risk of cardiovascular death. The immediate effects of hemodialysis on cardiac function are poorly understood. We hypothesized that hemodialysis may have a detrimental effect on cardiac function and that symptoms during and after dialysis correlate with deterioration of cardiac function during dialysis.
Methods: Forty patients underwent echocardiography directly before and during the last hour of dialysis. We measured change in diastolic function, ejection fraction and wall motion score. Intradialytic symptoms such as cramping and fatigue lasting more than 2 hours after dialysis were evaluated by questionnaire. Echocardiograms were read by a single blinded reader at a reading center.
Results: During dialysis, diastolic function worsened in 32% and improved in 12% (two-sided p=0.03 for difference between proportions). Ejection fraction did not change (mean±SD: 0±4%). Wall motion score worsened in 23% and improved in 5% (p=0.02). Diabetics were at higher risk for worsening diastolic function (RR 3.4, p=0.02, 95%CI 1.2-10). Symptoms during dialysis or postdialysis fatigue were associated with worsened diastolic function (RR 7.9, p<0.001, 95% CI 1.9-33) and worsened wall motion (RR 7.2, p=0.01, 95% CI 1.5-35). Changes in cardiac function were not associated with intradialytic hypotension or ultrafiltration volume.
Conclusions: Our findings support our hypothesis that a significant proportion of patients experience deterioration of diastolic and systolic function during hemodialysis. These changes may reflect recurrent myocardial ischemia or injury. Diabetic status and symptoms during or after dialysis may help identify such patients, who may benefit from therapies aimed at improving cardiac function during dialysis.
- © 2011 by American Heart Association, Inc.