Haemodialysis acutely deteriorates left and right diastolic function and myocardial performance: an effect related to high ultrafiltration volumes?

Abstract

Background: The effect of acute preload reduction during haemodialysis on left ventricle (LV) and right ventricle (RV) function is not well understood. This study aimed to evaluate acute changes in novel echocardiographic and tissue Doppler-derived indices of LV and RV function during the first and a standard weekly dialysis session and to examine the possible effect of acute intradialytic volume changes in LV and RV diastolic function and pulmonary circulation loading.

Methods: Forty-one adult patients receiving standard thrice-weekly haemodialysis participated in this study. Two-dimensional echocardiographic and tissue Doppler imaging (TDI) studies were performed with a standard cardiac ultrasound device (Vivid 7 or Vivid e, GE, Horton, Norway) shortly before and after the first weekly and a standard dialysis session. Multiple linear regression analysis was applied to assess the effect of volume changes on peak early mitral (E) and tricuspid (E RV) velocities changes.

Results: Significant reductions from pre- to post-haemodialysis were noted in body weight and systolic blood pressure. Post-haemodialysis left and right atrial, LV and RV sizing echocardiographic parameters were lower. LV systolic function, represented by LV ejection fraction, cardiac output and mean peak systolic LV and RV velocities at the annulus level, was unchanged. Diastolic function indices such as E (first session: 0.96 ± 0.28 versus 0.75 ± 0.27 m/s, P < 0.001; standard session: 0.89 ± 0.24 versus 0.78 ± 0.29, P < 0.001) and E RV (first session: 0.89 ± 0.26 versus 0.67 ± 0.25 m/s, P < 0.001; standard session: 0.86 ± 0.24 versus 0.77 ± 0.31, P < 0.001), E/A LV ratio, TDI peak early mitral (E') velocity and E'/A' RV ratio were reduced after haemodialysis. Pulmonary circulation loading, represented by RV systolic pressure, was significantly improved. In multiple regression model analysis, intradialytic weight loss was independently associated with changes in E [β = 0.042 (95% CI 0.018-0.066)] and E RV [β = 0.084 (95% CI 0.057-0.110)].

Conclusions: This study shows that haemodialysis deteriorates cardiac diastolic function indices and improves pulmonary circulation loading, while systolic function remains unchanged. High intradialytic volume removal may affect cardiac diastolic function.

Keywords: diastolic dysfunction; echocardiography; haemodialysis; right ventricular systolic pressure; tissue Doppler imaging.