Left-Ventricular Diastolic Dysfunction as a Risk Factor for Dialytic Hypotension

OBJECTIVES: Intradialytic hypotension may adversely affect the outcome of chronic hemodialysis and thus reduce the patients' life expectancy. The aim of this study was to assess the link between left-ventricular diastolic dysfunction and dialytic hypotension. METHODS: We performed a prospective cross-sectional study of 72 hemodialysis patients with a low dialysis vintage, 36 of whom had dialysis hypotension, based on echocardiography and brain natriuretic peptide (BNP) assay. RESULTS: There was no difference between normotensive patients and those with dialysis-associated chronic hypotension as regards BNP level, cardiac index, left-ventricular ejection fraction, or myocardial fractional shortening. Both hypotension-prone patients requiring dialysate sodium profiling and chronic refractory hypotensive patients requiring macromolecule infusion had cardiac diastolic dysfunction as shown by a similarly abnormal E/A ratio <1 in 89-91% of cases, associated with a significant decrease in color M-mode diastolic flow propagation velocity (V(p), p < 0.05 nonparametric ANOVA). The area under the ROC curve for V(p) was 0.69. A V(p) cutoff of 39.5 cm/s was optimal for predicting dialysis-associated hypotension. CONCLUSIONS: We conclude that diastolic dysfunction is associated with dialytic hypotension and that a low V(p)--a preload-independent index--is predictive of dialysis-associated hypotension.