Key result
Hemodialysis significantly increased the subendocardial viability ratio (SEVR) by 43.8% and 26.1% after 3-day and 2-day interdialytic intervals, respectively, correlating strongly with reductions in overhydration.
Why the study?
Does hemodialysis alter cardiovascular hemodynamics and subendocardial viability ratio (SEVR) in anuric hemodialysis patients?
Observational (n=35)
No
Does hemodialysis alter cardiovascular hemodynamics and subendocardial viability ratio (SEVR) in anuric hemodialysis patients?
Effect estimate: 43.8% increase
Absolute Event Rate: 183.8% vs 129.9%
p-value: p=<0.001
Hemodialysis significantly alters cardiovascular hemodynamics, with fluid removal (reduction in overhydration) strongly correlating with improved subendocardial viability ratio (SEVR), highlighting the importance of careful fluid management for cardiac function.
Hypothesis-generating in Level 5 data; leaves open whether SEVR changes affect outcomes or guide volume management in dialysis.
Valuable information about cardiovascular system can be derived from the shape of aortic pulse wave being the result of reciprocal interaction between heart and vasculature. Pressure profiles in ascending aorta were obtained from peripheral waveforms recorded non-invasively (SphygmoCor, AtCor Medical, Australia) before, during and after hemodialysis sessions performed after 3-day and 2-day interdialytic intervals in 35 anuric, prevalent hemodialysis patients. Fluid status was assessed by Body Composition Monitor (Fresenius Medical Care, Bad Homburg, Germany) and online hematocrit monitoring device (CritLine, HemaMetrics, Utah). Systolic pressure and ejection duration decreased during dialysis. Augmentation index remained stable at 30 ± 13% throughout hemodialysis session despite the decrease of augmented pressure and pulse height. Subendocardial viability ratio (SEVR) determined after 3-day and 2-day interdialytic intervals increased during the sessions by 43.8 ± 26.6% and 26.1 ± 25.4%, respectively. Hemodialysis performed after 3-day and 2-day interdialytic periods reduced significantly overhydration by 2.4 ± 1.0 L and 1.8 ± 1.2 L and blood volume by 16.3 ± 9.7% and 13.7 ± 8.9%, respectively. Intradialytic increase of SEVR correlated with ultrafiltration rate (R = 0.39, p-value < 0.01), reduction in overhydration (R = -0.57, p-value < 0.001) and blood volume drop (R = -0.38, p-value < 0.01). The strong correlation between the decrease of overhydration during hemodialysis and increase in SEVR confirmed that careful fluid management is crucial for proper cardiac function. Hemodialysis affected cardiovascular system with the parameters derived from pulse-wave-analysis (systolic and augmented pressures, pulse height, ejection duration, SEVR) being significantly different at the end of dialysis from those before the session. Combination of pulse-wave-analysis with the monitoring of overhydration provides a new insight into the impact of hemodialysis on cardiovascular system.
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Dębowska et al. (2018) conducted an observational in End-stage renal disease on hemodialysis (n=35). Hemodialysis vs. Pre-hemodialysis baseline was evaluated on Subendocardial viability ratio (SEVR) after 3-day interdialytic interval (43.8% increase, p=<0.001). Hemodialysis significantly increased the subendocardial viability ratio (SEVR) by 43.8% and 26.1% after 3-day and 2-day interdialytic intervals, respectively, correlating strongly with reductions in overhydration.
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