Echocardiographic Indices in Hemodialysis Patients in a Six-Month Observation

Background. Cardiovascular diseases are the leading cause of premature mortality and disability of dialyzed patients. Generally, in the course of hemodialysis (HD) treatment, the prevalence and severity of left ventricular dysfunction (LVD) increase. Objectives. To investigate changes in echocardiographic parameters that could be early signs of the development or further deterioration of LVD in HD patients. Material and Methods. Echocardiography (two-dimensional, pulsed wave, continuous wave and tissue Doppler) was performed on 48 patients before and after HD sessions at the beginning of the study and after 6 months of HD treatment using Pro-Sound 4000 (Aloka, Japan). HD adequacy and laboratory parameters were evaluated. Unfavorable differences in the echocardiographic parameters of patients without changes in classification of left ventricular function over the study period were assumed to be early predictors for the development or deterioration of LVD. Results. In 31 patients, left ventricular function remained stable, in 12 it deteriorated and in 5 it improved. In the patients with stable function, left atrial (LA) diameter and area were greater before HD sessions, and the differences induced by HD sessions in left atrial and right atrial (RA) diameters were significantly greater at the end of the study than at the beginning (p < 0.05). The ultrafiltration volume (2155 +/- 926 mL vs. 2177 +/- 952 mL, p = 0.666) and inferior vena cava diameter (22.8 +/- 2.6 mm vs. 22.7 +/- 2.9 mm, p = 0.764) were not different at the beginning and at the end of the study. Differences in LA and RA diameters (among others) were also noted in 12 patients who showed a worsening in their left ventricular function classification. Conclusions. Increasing atrial diameters under comparable hypervolemic conditions before HD sessions may be considered an early predictive sign of deterioration of left ventricular function in HD patients (Adv Clin Exp Med 2011, 20, 4, 431-440).