Hemodialysis-induced regional left ventricular systolic dysfunction: prevalence, patient and dialysis treatment-related factors, and prognostic significance

Abstract

Background and objectives: 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.

Design, setting, participants, & measurements: 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.

Results: 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.

Conclusions: 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.

Figure 1.

Recruitment process of study participants.

Figure 2.

The course of systolic and diastolic BP, heart rate, and blood volume change in patients with and without hemodialysis-induced regional left ventricular (LV) systolic dysfunction (mean ± SD).

Figure 3.

The course of acid–base parameters (plasma bicarbonate and blood pH) and electrolytes (plasma sodium, potassium, ionized and albumin-corrected calcium, and magnesium levels) in patients with and without hemodialysis-induced regional LV systolic dysfunction (mean ± SD).

Figure 4.

Kaplan–Meier curve of all-cause mortality in patients with and without hemodialysis-induced regional LV systolic dysfunction.

Figure 5.

Kaplan–Meier curve of all-cause mortality in patients who did not develop regional wall abnormalities and patients with an increasing number of LV segments developing regional wall motion abnormalities during hemodialysis.