Key result
Verapamil treatment resulted in symptomatic improvement, increased nadir intradialysis blood pressure, and reduced intradialytic hypertensive episodes and need for intravenous saline.
Why the study?
Does verapamil improve symptoms and hemodynamics in chronic hemodialysis patients with refractory pulmonary congestion, left ventricular hypertrophy, and well-preserved systolic function?
Case Report (n=4)
Does verapamil improve symptoms and hemodynamics in chronic hemodialysis patients with refractory pulmonary congestion, left ventricular hypertrophy, and well-preserved systolic function?
Verapamil may provide symptomatic and hemodynamic benefits in chronic hemodialysis patients with refractory congestive heart failure, left ventricular hypertrophy, and preserved systolic function.
May offer symptomatic relief in select hemodialysis patients with LVH; hypothesis-generating and requires prospective trials before practice change.
Echocardiographic evidence of left ventricular hypertrophy with well-preserved systolic function was established in 4 chronic hemodialysis patients with a history of refractory pulmonary congestion. In each patient a trial of treatment with verapamil (40 mg t.i.d.) resulted in symptomatic improvement, an increase in nadir intradialysis blood pressure, and a marked reduction in intradialytic symptomatic hypertensive episodes and the need for intravenous saline administration. These data suggest that (a) a subset of chronic hemodialysis patients with refractory congestive heart failure and dialysis-related hypotension have hypertrophic cardiomyopathy with well-preserved systolic function, and (b) such patients may derive greater benefit from verapamil treatment than from the more conventional approach to drug therapy with digoxin and nitrates.
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Whelton et al. (1987) conducted a case report in Chronic hemodialysis with left ventricular hypertrophy and refractory pulmonary congestion (n=4). Verapamil was evaluated on Symptomatic improvement, nadir intradialysis blood pressure, intradialytic symptomatic hypertensive episodes, and need for intravenous saline administration. Verapamil treatment resulted in symptomatic improvement, increased nadir intradialysis blood pressure, and reduced intradialytic hypertensive episodes and need for intravenous saline.
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