Key result
A single hemodialysis session significantly improved global myocardial systolic velocity in ESRD patients without diabetes or coronary artery disease (from 6.3 to 7.9 cm/s, p<0.001), but not in those with these comorbidities.
Why the study?
Does a single session of hemodialysis improve myocardial function in end-stage renal disease patients with and without type 2 diabetes mellitus and coronary artery disease?
Observational (n=46)
No
Does a single session of hemodialysis improve myocardial function in end-stage renal disease patients with and without type 2 diabetes mellitus and coronary artery disease?
A single hemodialysis session acutely improves left ventricular function only in end-stage renal disease patients without coexistent diabetes or coronary artery disease.
Answers are grounded in this paper and cite their sources.
Hemodialysis-associated LV velocity gains appear limited to ESRD without comorbidities; hypothesis-generating and should not yet change practice.
BACKGROUND: Though hemodialysis (HD) acutely improves cardiac function, the impact of background diseases like coronary artery disease (CAD) and Type 2 diabetes (DM) in the setting of end-stage renal disease (ESRD) is not known. Tissue velocity echocardiography (TVE) offers a fast choice to follow changes in myocardial function after HD in ESRD with concomitant DM and /or CAD. METHODS: 46 subjects (17 with ESRD, Group 1; 15 with DM, Group 2; 14 with DM+CAD, Group 3) underwent standard and TVE prior to and shortly after HD. Besides standard Doppler variables, regional myocardial systolic and diastolic velocities, as well as systolic strain rate were post processed. RESULTS: Compared with pre-HD, post-HD body weight (kg) significantly decreased in all the three groups (51 +/- 9 vs. 48 +/- 8, 62 +/- 10 vs.59 +/- 10, and 61 +/- 9 vs. 58 +/- 9 respectively; all p < 0.01). Left ventricular end diastolic dimensions (mm) also decreased post- HD (46 +/- 5 vs. 42 +/- 7, 53 +/- 7 vs. 50 +/- 7, 51 +/- 7 vs. 47 +/- 8 respectively; all p < 0.01). Regional longitudinal peak systolic velocity in septum (cm/s) significantly increased post-HD in Group 1(5.7 +/- 1.6 vs. 7.2 +/- 2.3; p < 0.001) while remained unchanged in the other two groups. Similar trends were noted in other left ventricular walls. When the myocardial velocities (cm/s) were computed globally, the improvement was seen only in Group 1 (6.3 +/- 1.5 vs. 7.9 +/- 2.0; p < 0.001). Global early regional diastolic velocity (cm/s) improved in Group 1, remained unchanged in Group 2, while significantly decreased in Group 3(-5.9 +/- 1.3 vs. -4.1 +/- 1.8; p < 0.01). Global systolic strain rate (1/sec) increased in the first 2 Groups but remained unchanged (-0.87 +/- 0.4 vs. -0.94 +/- 0.3; p = ns) in Group 3. CONCLUSION: A single HD session improves LV function only in ESRD without coexistent DM and/or CAD. The present data suggest that not only dialysis-dependent changes in loading conditions but also co-existent background diseases determine the myocardial response to HD.
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Govind et al. (2006) conducted an observational in End-stage renal disease with or without Type 2 diabetes mellitus and coronary artery disease (n=46). Single session of hemodialysis vs. Pre-hemodialysis (baseline) was evaluated on Global myocardial systolic velocity (cm/s) in ESRD patients without DM/CAD (p=<0.001). A single hemodialysis session significantly improved global myocardial systolic velocity in ESRD patients without diabetes or coronary artery disease (from 6.3 to 7.9 cm/s, p<0.001), but not in those with these comorbidities.
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