Key result
Lower septal E/e' ratio is strongly linked to intradialytic hypotension in maintenance hemodialysis patients.
Why the study?
Intradialytic hypotension is a frequent and grave complication of hemodialysis, but dynamic hemodynamic changes and cardiac performances during dialytic sessions have been rarely explored.
Does dynamic echocardiographic assessment of septal E/e' ratio predict intradialytic hypotension in maintenance hemodialysis patients with preserved ejection fraction?
Case-Control (n=76)
Does dynamic echocardiographic assessment of septal E/e' ratio predict intradialytic hypotension in maintenance hemodialysis patients with preserved ejection fraction?
Effect estimate: OR 0.040 (95% CI 0.003-0.606)
p-value: p=0.02
Dynamic echocardiographic assessment reveals that a lower septal E/e' ratio is an independent predictor of intradialytic hypotension in hemodialysis patients with preserved ejection fraction.
May support E/e' for IDH risk stratification in preserved-EF hemodialysis; hypothesis-generating and requires prospective validation before practice change.
Background: Intradialytic hypotension (IDH) is a frequent and grave complication of hemodialysis (HD). However, the dynamic hemodynamic changes and cardiac performances during each dialytic session have been rarely explored in patients having IDH. Methods: Seventy-six HD patients (IDH = 40, controls = 36) were enrolled. Echocardiography examinations were performed in all patients at the pre-HD, during-HD and post-HD phases of a single HD session. A two-way analysis of variance was applied to compare differences of echocardiographic parameters between IDH and controls over time. The risk association was estimated by using a logistic regression analysis. Results: The IDH patients had a higher ejection fraction during HD followed by a greater reduction at the post-HD phase than the controls. Significant decreases in septal ratios of transmitral flow velocity to annular velocity (E/e’) over times were detected between IDH patients and controls after adjusting for gender, age and ultrafiltration (p = 0.016). A lower septal E/e’ ratio was independently associated with IDH (OR = 0.040; 95% CI = 0.003–0.606; p = 0.02). In contrast, significant systolic and diastolic dysfunctions over time were found in diabetic IDH compared to non-diabetic counterparts. Conclusion: The septal E/e’ ratio was a significant predictor for IDH.
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Chen et al. (2021) conducted a case-control in Intradialytic hypotension in maintenance hemodialysis (n=76). Lower septal E/e' ratio vs. Controls (HD patients without IDH) was evaluated on Intradialytic hypotension (OR 0.040, 95% CI 0.003-0.606, p=0.02). A lower septal E/e' ratio was independently associated with intradialytic hypotension in maintenance hemodialysis patients (OR 0.040; 95% CI 0.003-0.606; p=0.02).
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