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July 14, 2026Clinical HypertensionOpen Access

Dynamic changes in right ventricular free wall strain during hemodialysis identify patients at risk for intradialytic hypotension

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Why the study?

Intradialytic hypotension is a frequent hemodialysis complication linked to adverse cardiovascular consequences, but the contribution of RV functional reserve to hemodynamic stability during dialysis remains unclear.

Does dynamic change in right ventricular free wall strain during hemodialysis predict intradialytic hypotension in patients with end-stage renal disease?

Population

50 patients with end-stage renal disease undergoing maintenance hemodialysis (33 analyzed)

Comparison

Patients with IDH vs patients without IDH

Design

Prospective single-center study with blinded offline analysis

Key result

Patients who developed intradialytic hypotension exhibited a significantly greater post-dialysis reduction in right ventricular free wall strain compared to those without hypotension (-7.0% vs -1.7%, P=0.017).

Authors

BKBong‐Joon KimSKSoo Jin KimSISung Il Im

Discussion

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Overview

Intradialytic hypotension was associated with greater right ventricular strain reduction; hypothesis-generating and requires prospective validation before clinical adoption.

Key Points

  • This study investigates the relationship between dynamic changes in right ventricular strain and the occurrence of intradialytic hypotension during hemodialysis.
  • Prospective single-center study involving 50 end-stage renal disease patients undergoing hemodialysis.
  • Comprehensive echocardiography with speckle-tracking analysis to assess right ventricular free wall strain before and after dialysis.
  • Intradialytic hypotension was defined as a decrease in systolic blood pressure (SBP) of ≥ 20 mmHg.
  • In 33 analyzed patients, 15 (45%) developed intradialytic hypotension.
  • Patients with IDH exhibited a significantly greater post-dialysis reduction in right ventricular free wall strain (-7.0 ± 7.2% vs. -1.7 ± 4.6%, P = 0.017).
  • A moderate positive correlation was found between SBP decline and RVFWS decrease (r = 0.50, P = 0.003).

Study Design

Type

Observational (n=33)

Blinding

Single-blind (offline strain analysis)

Multicenter

No

Structured PICO

Does dynamic change in right ventricular free wall strain during hemodialysis predict intradialytic hypotension in patients with end-stage renal disease?

P
Population
33 patients with end-stage renal disease undergoing maintenance hemodialysis, evaluated for dynamic changes in right ventricular strain before and after a single dialysis session.
E
Exposure
Comprehensive transthoracic echocardiography with speckle-tracking analysis of right ventricular free wall strain (RVFWS) immediately before and after a scheduled hemodialysis session.
C
Comparator
Patients who did not develop intradialytic hypotension (IDH) compared to those who did.
O
Outcome
Intradialytic hypotension (IDH), defined as a decrease in systolic blood pressure (SBP) of ≥ 20 mmHg from pre- to post-dialysis.

Main Result

Absolute Event Rate: -7% vs -1.7%

p-value: p=0.017

Dynamic assessment of right ventricular free wall strain during hemodialysis can help identify patients with impaired right ventricular contractile reserve who are at risk for intradialytic hypotension.

Limitations

  • Single-center study with a relatively small sample size.
  • Substantial number of patients excluded due to inadequate image quality, introducing potential selection bias.
  • Observational design precludes causal inference between RV functional deterioration and IDH.
  • RVFWS is load-dependent and may be influenced by acute preload and afterload changes during dialysis.
  • Absence of invasive hemodynamic measurements limits direct assessment of RV pressures and RV-PA coupling.
  • IDH definition based on intermittent pre- to post-dialysis SBP changes may miss transient hypotensive events.
  • Long-term outcomes were not evaluated.
  • Single-center study with a relatively small sample size
  • Substantial number of patients excluded due to inadequate image quality (selection bias)
  • Observational design precludes causal inference
  • RVFWS is load-dependent and influenced by acute preload and afterload changes
  • Absence of invasive hemodynamic measurements
  • Definition of IDH based on intermittent BP monitoring rather than continuous
  • Long-term outcomes were not evaluated

Cite This Study

Kim et al. (2026) conducted an observational in End-stage renal disease (n=33). Intradialytic hypotension (IDH) vs. No intradialytic hypotension was evaluated on Post-dialysis reduction in right ventricular free wall strain (RVFWS) (p=0.017). Patients who developed intradialytic hypotension exhibited a significantly greater post-dialysis reduction in right ventricular free wall strain compared to those without hypotension (-7.0% vs -1.7%, P=0.017).

synapsesocial.com/papers/6a5600ff10535b590d1623eahttps://doi.org/10.5646/ch.2026.32.e35
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