Received June 12, 2006
Accepted on August 24, 2006
Dialysis-Induced Regional Left Ventricular Dysfunction Is Ameliorated by Cooling the Dialysate
Nicholas M. Selby *,
James O. Burton *,
Lindsay J. Chesterton *,
and
Christopher W. McIntyre *
1
*Department of Renal Medicine, Derby City Hospital, Derby, and Centre for Integrated Systems Biology and Medicine, University of Nottingham, Nottingham, United Kingdom
1 To whom correspondence should be addressed. E-mail: chris.mcintyre{at}derbyhospitals.nhs.uk.
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Abstract |
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Dialysis patients who develop cardiac failure have a poor prognosis. Recurrent subclinical myocardial ischemia is important in the genesis of heart failure in nondialysis patients. It has previously been demonstrated that subclinical ischemia occurs during hemodialysis; therefore, this study examined whether the improved stability of cool-temperature dialysis lessens this phenomenon. Ten patients who were prone to intradialytic hypotension entered a randomized, crossover study to compare the development of dialysis-induced left ventricular (LV) regional wall motion abnormalities (RWMA) at dialysate temperatures of 37 and 35°C. Serial echocardiography with quantitative analysis was used to assess ejection fraction and regional systolic LV function. BP and hemodynamic variables were measured using continuous pulse wave analysis. The severity of thermal symptoms was scored using a simple questionnaire. Forty-nine new RWMA developed in nine patients during hemodialysis with dialysate at 37°C (HD37), compared with thirteen RWMA that developed in four patients during HD35 (odds ratio 3.8; 95% confidence interval 2.1 to 6.9). The majority of RWMA displayed improved function by 30 min after dialysis. Overall, regional systolic LV function was significantly more impaired during HD37 (P < 0.001). BP was higher during HD35, with fewer episodes of hypotension as a result of a higher peripheral resistance and no difference in stroke volume. The development of thermal symptoms was heterogeneous, with most patients tolerating HD35 well. This study confirms previous findings of reversible LV RWMA that develop during hemodialysis. It also shows that this phenomenon can be ameliorated by reducing dialysate temperature, a simple intervention with no cost implications.
