Doppler ultrasound evaluation of morphological and hemodynamical changes of hepatic and mesenteric structures in end-stage renal disease patients on regular hemodialysis

Abstract

The goal of the present study is to sonographically investigate the effects of hemodialysis on the hepatic and mesenteric circulation in end-stage renal disease (ESRD) patients on a regular-basis hemodialysis and compare with healthy subjects. Twenty ESRD patients on regular hemodialysis and 20 control subjects were included in the study. Measurements of the diameter, mean velocity, and volume flow of the portal vein (PV), hepatic artery (HA), and superior mesenteric artery (SMA) were obtained in ESRD patients on a regular hemodialysis program (30 min before and after dialysis procedure) and in healthy subjects. After hemodialysis procedure, increase in the diameters of the HA (P = 0.023), SMA (P = 0.017), and PV (P = 0.04), decrease in the mean flow velocities of the HA (P = 0.0001), SMA (P = 0.0001), and PV (P = 0.001) and decrease in the volume flow of the HA (P = 0.037), SMA (P = 0.013), and PV (P = 0.033) were noticed. On the other hand, comparison of vessel diameters (HA: P = 0.429; SMA: P = 0.968; PV: P = 0.529), mean flow velocities (HA: P = 0.989; SMA: P = 0.149; PV: P = 0.221), and volume flow values (HA: P = 0.82; SMA: P = 0.795; PV: P = 0.512) of the control group and the ESRD patients group before dialysis procedure showed no statistically significant difference. Hemodialysis is demonstrated to have acute and important effects on mesenteric and hepatic circulation (increase in diameter and decrease in velocity and volume flow), as on other vascular beds. These hemodynamic and morphologic changes are reversible and easily evaluated using Doppler US.