gms | German Medical Science

Introduction: Patients with end-stage renal disease (ESRD) on hemodialysis (HD) are at high risk for car-diovascular disease. Little is known about the influence of HD on cardiac and vascular prop-erties and the question whether these parameters should be measured before or after HD. The aim of this study was to examine if measurement of left ventricular mass (LVM) and vascular compliance are influenced by HD treatment.

Methods: We examined 10 patients (8m, 2f), 53.1+/-10.6 ys, on HD. Large (C1) and small (C2) artery compliance was measured by applanation tonometry, LVM was calculated from MRI scans before HD and compared to echocardiography (Devereux's formula). Parameters for systolic function were LV ejection fraction (EF) and midwall fractional fiber shortening (midffs), for diastolic function the A/E-ratio of maximal transmitral flow velocity. LV geometry was inves-tigated by measurement of enddiastolic diameter (EDD), enddiastolic volume (EDV) and relative wall thickness (RWT).

Results: Body weight was 80.6+/-17.6kg before HD and 77.3+/-17.7kg after HD (p<0.001). LVM by echocardiography and MRI were correlated (r=0.743, p=0.014). Systolic blood pressure (SBP) (145+/-22 vs 137+/-26mmHg, p=0.02), EDD (55.3+/-5.0 vs. 52.0+/-4.8mm, p=0,045) and EDV (151+/-30 vs 131+/-27ml, p=0.047) decreased after HD. No significant changes were detected for diastolic blood pressure (DBP), C1, C2, midffs, EF and LVM. A/E-ratio changed from 0.78+/-0.24 to 1.15+/-0.44 (p=0.02) meaning ameliorated diastolic filling after HD and RWT increased (0.36+/-0.08 vs 0.39+/-0.08, p=0.04) pointing to more concentric remodeling of LVH.

Conclusion: HD induced volume changes showed no influence on vascular compliance. We have shown, that calculation of LVM by echocardiography (as compared to MRI) is a valid method also in patients on HD. Although both EDV and EDD were significantly reduced by HD this did not result in significant changes of LVM but in the judgement of the pattern of LVH.