PP.09.05] HEMODIALYSIS IMPROVES RIGHT VENTRICULAR SIZING AND REDUCES PULMONARY CIRCULATION LOADING IN PATIENTS WITH END-STAGE RENAL DISEASE

Abstract

Objective: The effect of acute pre-load reduction during hemodialysis on right ventricular (RV) function is not well understood. Accordingly, the aim of this study was to evaluate acute changes in novel echocardiographic and tissue Doppler-derived indices of RV function during the first and second weekly dialysis sessions. Design and method: A total of 41 adult patients receiving standard thrice-weekly hemodialysis for at least 3 months participated in this study. Two-dimensional echocardiographic and tissue-Doppler imaging studies were performed with a standard cardiac ultrasound device (Vivid 7, GE, Horten, Norway) shortly before and after the first and second weekly dialysis sessions. Results: Significant reductions from pre- to post dialysis were noted in body weight (1st session: 72.2 ± 12.6 vs 69.3 ± 12.5 kg, p < 0.001; 2nd session: 71.5 ± 12.7 vs 68.9 ± 12.5 kg, p < 0.001) and in systolic BP (1st session: 145.5 ± 21.6 vs 135.9 ± 23.5 mmHg, P < 0.05; 2nd session: 143.1 ± 19.8 vs 135.2 ± 20.4 mmHg, P < 0.05). RV end-diastolic diameter (1st session: 3.47 ± 0.97 vs 3.09 ± 0.83 cm, P < 0.001; 2nd session: 3.40 ± 0.83 vs 3.10 ± 0.88 cm, P < 0.001) and right atrial volume index (1st session: 27.33 ± 10.65 vs 21.30 ± 10.16 cm, P < 0.001; 2nd sessions: 27.83 ± 13.94 vs 23.04 ± 13.19 cm, P < 0.001) were reduced between the start and end of both sessions studied. Similarly, significant intradialytic reductions in inferior-vena-cava diameter were evident during both dialysis sessions (1st session: 1.93 ± 0.41 vs 1.54 ± 0.45 cm, P < 0.001; 2nd sessions: 1.76 ± 0.40 vs 1.37 ± 0.40 cm, P < 0.001). Acute pre-load reduction was accompanied by improvement in RV systolic pressure (1st session: 44.64 ± 16.25 vs 33.14 ± 12.43 mmHg, P < 0.001; 2nd session: 37.72 ± 14.46 vs 30.48 ± 13.36 mmHg, p < 0.001) and in tricuspid regurgitation maximum velocity (TRVmax) (1st session: 2.86 ± 0.54 vs 2.53 ± 0.54, cm/sec, P < 0.001; 2nd session: 2.68 ± 0.55 vs 2.46 ± 0.54 cm/sec, P < 0.001). Indices reflecting RV diastolic function remained unchanged from pre- to postdialysis in both sessions. RV systolic function assessed by peak systolic RV velocity (Sm-RV) remained stable in both occasions (1st session: 0.15 ± 0.04 vs 0.15 ± 0.04, m/sec P = 0.575; 2nd session 0.14 ± 0.03 vs 0.15 ± 0.04 m/sec; P = 0.149). Conclusions: This study shows that pre-load reduction during hemodialysis improves RV sizing parameters and reduces pulmonary circulation loading, without affecting the systolic and diastolic performance of right ventricle.