Hemodynamic effects of hemodialysis: the interaction between the heart and the arteries

Many studies report that cardiac function is affected by hemodialysis due to alterations in left ventricular morphology and function, particularly left ventricular hypertrophy. Left ventricular hypertrophy is primarily driven by pressure and volume overload, aggravated by factors such as arteriovenous fistulas, anemia, and fluid retention. In addition to left ventricular mass, hemodialysis can impair both left ventricular systolic and diastolic functions, leading to transient reductions in left ventricular ejection fraction, and global longitudinal strain, which are strongly linked to increased mortality. Moreover, chronic dialysis leads to changes in arterial structure and function, including increased intima-media thickness and reduced arterial distensibility, which result in increased afterload. Fluctuating blood pressure during dialysis further affects cardiac function, emphasizing the need for comprehensive assessment of both ventricular and arterial functions, a relationship defined as ventriculo-arterial coupling. In patients with kidney failure, ventriculo-arterial coupling serves as a valuable load-independent prognostic marker, enhancing risk prediction and stratification. Non-invasive tools like echocardiography and speckle-tracking techniques are currently available for evaluating these parameters, enabling early detection and intervention to mitigate cardiovascular risks in patients with kidney failure undergoing hemodialysis. These insights highlight the complex interplay between fluid management, left ventricular function, and arterial stiffness, emphasizing the importance of improved strategies to optimize cardiovascular outcomes in this high-risk population.