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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 6  |  Page : 1053-1057
Left and right ventricular diastolic function in hemodialysis patients


1 Department of Nephrology and Hemodialysis, Internal Medicine Clinic, University Clinic Centre of Kosova, Prishtina, Kosova
2 Department of Cardiology, Internal Medicine Clinic, University Clinic Centre of Kosova, Prishtina, Kosova

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Date of Web Publication4-Nov-2010
 

   Abstract 

The aim of this prospective study was the assessment of left ventricular and right ventricular diastolic function in patients on hemodialysis (HD) and the correlation of this func­tion with the duration of HD. The study included 42 patients (22 females and 20 males) with chro­nic renal failure (CRF), treated with HD, and 40 healthy subjects (24 females and 16 males) with no history of cardiovascular disease and with normal renal function, who constituted the control group. The groups were matched for age and sex. All study patients and control subjects under­went detailed history taking and physical examination. They also underwent electrocardiogram, echocardiography and biochemical and hematological blood analyses. Significant differences were noted between the two groups in the two-dimensional and M-mode echocardiography findings concerning aortic root dimension, transverse diameter of the left atrium, thickness of the inter-ventricular septum, thickness of the left ventricular posterior wall, left ventricular diastolic diameter, left ventricular systolic diameter, shortening fraction, ejection fraction as well as findings from the pulse Doppler study, including E wave, A wave, E/A ratio, deceleration time of E wave (DT-E), acceleration time of E wave (AT-E), tricuspid E and A waves (E tr and A tr ) and E tr /A tr , ratio. There were significant changes in HD patients without arterial hypertension as well in the control group subjects. Our study suggests that the left ventricular and left atrial dimensions as well as the left ventricular wall thickness are augmented in patients with CRF treated with HD compared with the control group. Additionally, the left and right ventricular diastolic function is also reduced in these patients. These differences were also noted in patients with CRF without arterial hypertension. Left ventricular diastolic dysfunction had no correlation with the duration of HD.

How to cite this article:
Rudhani ID, Bajraktari G, Kryziu E, Zylfiu B, Sadiku S, Elezi Y, Rexhepaj N, Vitia A, Emini M, Abazi M, Berbatovci-Ukimeraj M, Kryeziu K, Hsanagjekaj V, Korca H, Ukimeri A. Left and right ventricular diastolic function in hemodialysis patients. Saudi J Kidney Dis Transpl 2010;21:1053-7

How to cite this URL:
Rudhani ID, Bajraktari G, Kryziu E, Zylfiu B, Sadiku S, Elezi Y, Rexhepaj N, Vitia A, Emini M, Abazi M, Berbatovci-Ukimeraj M, Kryeziu K, Hsanagjekaj V, Korca H, Ukimeri A. Left and right ventricular diastolic function in hemodialysis patients. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2018 Jun 20];21:1053-7. Available from: http://www.sjkdt.org/text.asp?2010/21/6/1053/72291

   Introduction Top


Nearly half the deaths in patients with ter­minal renal disease treated with hemodialysis (HD) is due to cardiovascular complications. [1],[2] Arterial hypertension is present in 60-90% of the patients with renal failure before starting HD treatment. Congestive heart failure as a cause of mortality occurs in approximately 20-30% of the cases. [2].[3].[4] Echocardiography showed that hypertrophic cardiomyopathy was dominant in most of these patients, [5],[6] while decreased left ventricular function was found less frequently. [7] The most frequent cause of left ventricular sys­tolic dysfunction is coronary artery disease. [5],[6],[7] However, some patients on HD have decreased systolic function without coronary disease. [8] Pathophysiologic changes and prognosis of these patients still remains unclear. Diastolic dysfunction is responsible for approximately 30% of the patients with heart failure. [9]


   Aim of the study Top


The aim of this prospective study was the assessment of left ventricular and right ventri­cular diastolic function in patients on HD and the correlation of this finding with the duration of HD.


   Methods Top


This study was undertaken in the Departments of Nephrology and Hemodialysis and Cardio­logy in the Internal Clinic, UCC Kosova in Pristina, from January 2005 until September 2005. The study was performed on 42 patients (22 females and 20 males) with chronic renal failure (CRF) treated with HD and 40 healthy subjects (24 females and 16 males) without any history of cardiovascular disease or renal dysfunction, who constituted the control group. The groups were matched for age and sex. All patients in the case and in the control groups underwent detailed history and physical exa­mination as well as electrocardiography (ECG), echocardiography and biochemical and hemato­logical blood analyses.

Echocardiography scan

The echocardiography machine used for this study was the Agilent Image-Point machine with 2, 5 and 4.0 MHz probes. Echocardio­graphy scan was performed using the standard parasternal view (longitudinal and transversal axis) and apical views (two and four rooms) in the left decubitus position. On the echocardio­graphy scan, the following standard measure­ments were taken on two-dimensional echo­cardiogram and M-mode: aortic dimension (Ao), diameter of left atrium (LA), thickness of interventricular septum (IVS), thickness of left ventricular posterior wall (LVPW), left ventricular systolic diameter (LVsD), shorte­ning fraction (SF) and ejection fraction (EF). Assessment of the left ventricular diastolic function was made by a pulse Doppler study. The valuation of this function was made by the conventional method, by transmitral pulse Dop­pler and measuring the inflow speed of blood at the mitral valve level. The sample volume was set at the mitral valve leaflets level. The following transmitral inflow patterns were re­corded: early diastolic wave (E), atrial activity wave (A), ratio between these parameters (E/A), deceleration time (DT-E) and acceleration time (AT-E). The tricuspid inflow patterns were record-ed as well: early diastolic wave (E tr ), atrial activity wave (A tr ) and ratio between these parameters (E tr /A tr ).


   Statistical Analysis Top


Data are presented as mean ± SD. Paired Student's t-test was used to evaluate the varia­tions between the continuous variables. Fisher's exact test was used to compare variables between the groups. Values r of Pearson's cor­relation coefficient were calculated for pairs of continuous variables. P ≤ 0.05 was considered to be statistically significant.


   Results Top


There were significant differences in hemo­globin, red cell count, leukocyte count, choles­terol and tryglyceride levels between the pa­tients on HD and in the control group, while the difference in the blood glucose level was not significant [Table 1].
Table 1 :Comparison of the laboratory findings in hemodialysis patients and control subjects.

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Two-dimensional and M-mode echocardiogra­phic findings showed significant differences between the two groups in the following para­meters: aortic diameter (Ao), transverse left atrial diameter, interventricular septum thicknes, LVPW, LVdD, LVsD, SF and EF [Table 2]. Also, pulsed Doppler findings such as E wave, A wave, E/A ratio, deceleration time of E wave (DT-E), acceleration time of E wave (AT-E), tricuspid E and A waves (E tr and A tr ) and E tr /A tr , ratio showed significant changes [Table 3].
Table 2 :Comparison of the two-dimensional and M-mode findings in hemodialysis patients and subjects from the control group.

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Table 3 :Comparison of the pulse Doppler findings in the hemodialysis patients and subjects from the control group.

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Of the 42 HD patients, 25 (60%) had arterial hypertension and 17 (40%) had normal blood pressure before HD treatment. We compared the findings on two-dimensional and M-mode echocardiography as well as pulse Doppler in patients with and without hypertension as well as in subjects from the control group. The findings are depicted in [Table 4] and [Table 5]. Left ventricular diastolic function had no significant correlation with duration of HD [Figure 1].
Figure 1 :Correlation between hemodialysis duration and E/A ratio.

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Table 4 :Comparison of changes on two-dimensional and M-mode echocardiography findings between hemodialysis patients without AHT and the subjects from the control group.

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Table 5 :Comparison of the pulsed Doppler findings on the hemodialysis patients without AHT and subjects from the control group.

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   Discussion Top


Cardiovascular complications are commonly seen in patients with CRF, especially in those on HD. [1],[2],[3] The most common cardiovascular complications seen in these patients are AHT, IHD, AMI, disturbances of the heart rythm, etc. [1],[2],[3],[4] Cardiovascular mortality in these patients is very high. Echocardiography helps in detec­tion of left ventricular hypertrophy and de­crease in systolic function in these patients. [4],[5],[6],[7] Most of the previous studies showed de­creased left ventricular diastolic function. [7],[8],[9],[10],[11],[12],[13],[14],[15]

Our study is the first to assess right ven­tricular diastolic function in these patients. We found reduced right ventricular diastolic func­tion, which may be explained by the presence of left ventricular overload as well as increased pressure on the right heart. Furthermore, our study is the first to explore the left and right ventricular diastolic function in HD patients without AHT. We found that the left and right ventricular diastolic function is affected in these patients.

In conclusion, in patients with CRF treated with HD, the dimensions of the left ventricle, left atrium and left ventricular posterior wall thickness are augmented in comparison with subjects from the control group. Furthermore, the left and right ventricular diastolic function in these patients is reduced. These changes are also present in CRF patients without AHT. Left ventricular diastolic function has no sig­nificant corelation with the duration of HD.

 
   References Top

1.Levey AS. Controlling the epidemic of cardio­vascular disease in chronic renal disease: where do we start? Am J Kidney Dis 1998;32 (5 Suppl 3):S5-13.  Back to cited text no. 1
    
2.Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chro­nic renal disease. Am J Kidney Dis 1998;32(5 Suppl 3):S112-9.  Back to cited text no. 2
    
3.Mailloux LU, Levey AS. Hypertension in the ESRD patient: Pathophysiology, therapy, out­comes, and future directions. Am J Kidney Dis 1998;32(5):705-19.  Back to cited text no. 3
    
4.Harnett JD, Foley RN, Kent GM, Barre PE, Murray D, Parfrey PS. Congestive heart failure in dialysis patients: Prevalence, incidence, prog­nosis and risk factors. Kidney Int 1995;47(3): 884-90.  Back to cited text no. 4
    
5.Levin A, Singer J, Thompson CR, Ross H, Lewis M. Prevalent left ventricular hypertro­phy in the predialysis population: Identifying opportunities for intervention. Am J Kidney Dis 1996;27(3):347-54.  Back to cited text no. 5
    
6.Wizemann V, Blank S, Kramer W. Diastolic dysfunction of the left ventricle in dialysis patients. Contrib Nephrol 1994;106:106-9.  Back to cited text no. 6
[PUBMED]    
7.Foley RN, Parfrey PS, Kent GM, Harnett JD, Murray DC, Barre PE. Long-term evolution of cardiomyopathy in dialysis patients. Kidney Int 1998;54(5):1720-5.  Back to cited text no. 7
    
8.Aoki J, Ikari Y, Nakajima H, et al. Clinical and pathologic characteristics of dilated cardio­myopathy in hemodialysis patients. Kidney Int 2005;67(1):333-40.  Back to cited text no. 8
    
9.Gagliardi GM, Rossi S, Manes MT, et al. Impact of left ventricular patterns and diastolic dysfunction on hemodialysis patients. G Ital Nefrol 2004;21(1):45-50.  Back to cited text no. 9
    
10.Manes MT, Gagliardi M, Misuraca G, Rossi S, Chiatto M. Left ventricular geometric patterns and cardiac function in patients with chronic renal failure undergoing hemodialysis. Monaldi Arch Chest Dis 2005;64(1):27-32.  Back to cited text no. 10
    
11.Oguzhan A, Arinc H, Abaci A, et al. Preload dependence of Doppler tissue imaging derived indexes of left ventricular diastolic function. Echocardiography 2005;22(4):320-5.  Back to cited text no. 11
    
12.Ben Khalfallah A, Ghodhbane L, Tlili R, Annabi N. Doppler echocardiographic study of left ventricular diastolic function in hemodia­lysis patients. Arch Mal Coeur Vaiss 2005;98 (1):31-8.  Back to cited text no. 12
    
13.Aoki J, Ikari Y, Nakajima H, et al. Clinical and pathologic characteristics of dilated cardio­myopathy in hemodialysis patients. Kidney Int 2005;67(1):333-40.  Back to cited text no. 13
    
14.Ojanen S, Virtanen V, Koobi T, Mustonen J, Pasternack A. The effect of isolated ultrafil­tration on Doppler-derived indices of left ven­tricular diastolic function. Nephrol Dial Trans­plant 2004;19(12):3130-6.  Back to cited text no. 14
    
15.Gagliardi GM, Rossi S, Manes MT, et al. Impact of left ventricular patterns and diastolic dysfunction on hemodialysis patients. G Ital Nefrol 2004;21(1):45-50.  Back to cited text no. 15
    

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Correspondence Address:
Ibrahim Destan Rudhani
Department of Nephrology and Hemodialysis, University Clinical Center of Kosova, Prishtina, Kosova

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PMID: 21060173

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    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]

This article has been cited by
1 Left ventricular systolic strain in chronic kidney disease and hemodialysis patients
Seethala, S.
Cardiology Review. 2011; 27(1)
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    Abstract
    Introduction
    Aim of the study
    Methods
    Statistical Analysis
    Results
    Discussion
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