Hemodialysis-Induced Regional Left Ventricular Systolic Dysfunction: Prevalence, Patient and Dialysis Treatment-Related Factors, and Prognostic Significance

The hemodialysis procedure may acutely induce regional left ventricular systolic dysfunction. This study evaluated the prevalence, time course, and associated patient- and dialysis-related factors of this entity and its association with outcome. Hemodialysis patients (105) on a three times per week...

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Veröffentlicht in:Clinical journal of the American Society of Nephrology 2012-10, Vol.7 (10), p.1615-1623
Hauptverfasser: Assa, Solmaz, Hummel, Yoran M, Voors, Adriaan A, Kuipers, Johanna, Westerhuis, Ralf, de Jong, Paul E, Franssen, Casper F M
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container_issue 10
container_start_page 1615
container_title Clinical journal of the American Society of Nephrology
container_volume 7
creator Assa, Solmaz
Hummel, Yoran M
Voors, Adriaan A
Kuipers, Johanna
Westerhuis, Ralf
de Jong, Paul E
Franssen, Casper F M
description The hemodialysis procedure may acutely induce regional left ventricular systolic dysfunction. This study evaluated the prevalence, time course, and associated patient- and dialysis-related factors of this entity and its association with outcome. Hemodialysis patients (105) on a three times per week dialysis schedule were studied between March of 2009 and March of 2010. Echocardiography was performed before dialysis, at 60 and 180 minutes intradialysis, and at 30 minutes postdialysis. Hemodialysis-induced regional left ventricular systolic dysfunction was defined as an increase in wall motion score in more than or equal to two segments. Hemodialysis-induced regional left ventricular systolic dysfunction occurred in 29 (27%) patients; 17 patients developed regional left ventricular systolic dysfunction 60 minutes after onset of dialysis. Patients with hemodialysis-induced left ventricular systolic dysfunction were more often male, had higher left ventricular mass index, and had worse predialysis left ventricular systolic function (left ventricular ejection fraction). The course of blood volume, BP, heart rate, electrolytes, and acid-base parameters during dialysis did not differ significantly between the two groups. Patients with hemodialysis-induced regional left ventricular systolic dysfunction had a significantly higher mortality after correction for age, sex, dialysis vintage, diabetes, cardiovascular history, ultrafiltration volume, left ventricular mass index, and predialysis wall motion score index. Hemodialysis induces regional wall motion abnormalities in a significant proportion of patients, and these changes are independently associated with increased mortality. Hemodialysis-induced regional left ventricular systolic dysfunction occurs early during hemodialysis and is not related to changes in blood volume, electrolytes, and acid-base parameters.
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This study evaluated the prevalence, time course, and associated patient- and dialysis-related factors of this entity and its association with outcome. Hemodialysis patients (105) on a three times per week dialysis schedule were studied between March of 2009 and March of 2010. Echocardiography was performed before dialysis, at 60 and 180 minutes intradialysis, and at 30 minutes postdialysis. Hemodialysis-induced regional left ventricular systolic dysfunction was defined as an increase in wall motion score in more than or equal to two segments. Hemodialysis-induced regional left ventricular systolic dysfunction occurred in 29 (27%) patients; 17 patients developed regional left ventricular systolic dysfunction 60 minutes after onset of dialysis. Patients with hemodialysis-induced left ventricular systolic dysfunction were more often male, had higher left ventricular mass index, and had worse predialysis left ventricular systolic function (left ventricular ejection fraction). The course of blood volume, BP, heart rate, electrolytes, and acid-base parameters during dialysis did not differ significantly between the two groups. Patients with hemodialysis-induced regional left ventricular systolic dysfunction had a significantly higher mortality after correction for age, sex, dialysis vintage, diabetes, cardiovascular history, ultrafiltration volume, left ventricular mass index, and predialysis wall motion score index. Hemodialysis induces regional wall motion abnormalities in a significant proportion of patients, and these changes are independently associated with increased mortality. 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Hemodialysis-induced regional left ventricular systolic dysfunction occurs early during hemodialysis and is not related to changes in blood volume, electrolytes, and acid-base parameters.</description><subject>Acid-Base Equilibrium</subject><subject>Aged</subject><subject>Chi-Square Distribution</subject><subject>Female</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Netherlands - epidemiology</subject><subject>Original</subject><subject>Prevalence</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Renal Dialysis - adverse effects</subject><subject>Renal Dialysis - mortality</subject><subject>Risk Factors</subject><subject>Stroke Volume</subject><subject>Systole</subject><subject>Time Factors</subject><subject>Ultrasonography</subject><subject>Ventricular Dysfunction, Left - diagnostic imaging</subject><subject>Ventricular Dysfunction, Left - epidemiology</subject><subject>Ventricular Dysfunction, Left - mortality</subject><subject>Ventricular Dysfunction, Left - physiopathology</subject><subject>Ventricular Function, Left</subject><issn>1555-9041</issn><issn>1555-905X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkU9vFCEchidGY2v15tlw9LBT-TMwrAcTs7W2ZqObthpvhAFmloaBCkyb_S79sLJ2u-oJ8uPheSFvVb1G8BhjRN8tvnw9hpBTiBB-Uh0iSmk9h_Tn0_2-QQfVi5SuIWwagunz6gBjjjFEzWF1f2bGoK10m2RTfe71pIwGF2awwUsHlqbP4IfxOVo1ORnB5Sbl4KwCJ5vUT17lwr0Hq2hupTNemRlYyWzLBSC9Bic7MbiKRuaxjOsL42QuEadS5RDT7A-3imHwIeXivbSDt71VssheVs966ZJ5tVuPqu-nn64WZ_Xy2-fzxcdlrQhhuaaSUs7nuOu7roey07zVpOWsbTjreq5pSxrFlVaE9fMyIajnmDKiGWsh05AcVR8evDdTNxqttv-VTtxEO8q4EUFa8f-Jt2sxhFtBGkYwJEXwdieI4ddkUhajTco4J70JUxIIzmlDG0x5QWcPqIohpWj6fQyCYluoKIWKx0IL_ubfp-3hxwb_Rq_tsL6z0Yg0SucKjoW6lsm3WzFiiJLfk6qtgg</recordid><startdate>20121001</startdate><enddate>20121001</enddate><creator>Assa, Solmaz</creator><creator>Hummel, Yoran M</creator><creator>Voors, Adriaan A</creator><creator>Kuipers, Johanna</creator><creator>Westerhuis, Ralf</creator><creator>de Jong, Paul E</creator><creator>Franssen, Casper F M</creator><general>American Society of Nephrology</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20121001</creationdate><title>Hemodialysis-Induced Regional Left Ventricular Systolic Dysfunction: Prevalence, Patient and Dialysis Treatment-Related Factors, and Prognostic Significance</title><author>Assa, Solmaz ; 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subjects Acid-Base Equilibrium
Aged
Chi-Square Distribution
Female
Hemodynamics
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Netherlands - epidemiology
Original
Prevalence
Prognosis
Proportional Hazards Models
Renal Dialysis - adverse effects
Renal Dialysis - mortality
Risk Factors
Stroke Volume
Systole
Time Factors
Ultrasonography
Ventricular Dysfunction, Left - diagnostic imaging
Ventricular Dysfunction, Left - epidemiology
Ventricular Dysfunction, Left - mortality
Ventricular Dysfunction, Left - physiopathology
Ventricular Function, Left
title Hemodialysis-Induced Regional Left Ventricular Systolic Dysfunction: Prevalence, Patient and Dialysis Treatment-Related Factors, and Prognostic Significance
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