The Ebb and Flow of Echocardiographic Cardiac Function Parameters in Relationship to Hemodialysis Treatment in Patients with ESRD

Abstract

Cardiovascular disease is the leading cause of mortality in patients receiving hemodialysis. Cardiovascular events in these patients demonstrate a day-of-week pattern; i.e., they occur more commonly during the last day of the long interdialytic interval and the first session of the week. The hemodialysis process causes acute decreases in cardiac chamber size and pulmonary circulation loading and acute diastolic dysfunction, possibly through myocardial stunning and other non-myocardial-related mechanisms; systolic function, in contrast, is largely unchanged. During interdialytic intervals volume overload, acid-base, and electrolyte shifts, as well as arterial and myocardial wall changes, result in dilatation of right cardiac chambers and pulmonary circulation overload. Recent studies suggest that these alterations are more extended during the long interdialytic interval or the first dialysis session of the week and are associated with excess volume overload or removal, respectively, thus adding a mechanism for the day-of-week pattern of mortality in patients receiving hemodialysis. This review summarizes the existing data from echocardiographic studies of cardiac morphology and function during the hemodialysis session, as well as during the interdialytic intervals.

Keywords: diastolic dysfunction; echocardiography; hemodialysis; interdialytic interval; myocardial stunning; pulmonary circulation overload.

Figure 1.

PET imaging of the heart during hemodialysis. Relative change from baseline of the (A) LV end-diastolic volume, (B) LV end-systolic volume, (C) cardiac output, and (D) myocardial blood flow. Each line represents an individual patient. In each of these figures, the same symbols are used for individual patients. Reprinted from reference , with permission. NR, number.

Figure 2.

Changes in echocardiographic indices of LV and RV remodeling and function during the 3-day and 2-day interdialytic intervals. Interdialytic changes in stroke volume (SV) and LVMi were similar, but interdialytic changes in left atrial volume index (LAVi), right atrial volume index (RAVi), tricuspid regurgitation peak gradient (PGr TVR), and RVSP were greater during the 3-day compared with the 2-day interval, suggesting increased pulmonary circulation and right ventricle loading over the 3-day period. (Illustration based on results from Tsilonis et al.)