EFFECTS OF A HEMODIALYSIS SESSION ON TRANSMITRAL BLOOD FLOW

THEAIM of the work was to investigate the effects of a hemodialysis (HD) session on transmitral blood flow. PATIENTS AND METHODS. Echocargiographyand doppler echocargiography were carried out in 27 patients (15 women and 12 men, average age 49±12 years) before and after bicarbonate 4 hour long HD. Maximum rates of the early (E) and late (A) diastolic filling and their ratio (E/A), time of isovolumic relaxation of the left ventricle (IVRT), time of slowing down the early diastolic flow (DT) were determined. The concentration of sodium, potassium, calcium, magnesium in blood serum were determined before and after HD. RESULTS. Hemodialysis resulted in the reduction of the maximal rate in E peak from 98.3± 24.8 to 76.5±23.8 cm/c (p<0.001), and the rate in A peak did not substantially change, the E/A ratio decreased (from 1.21 ±0.59 to 0.95±0.43; p=0.009). IVRT and DT did not substantially change. A direct correlation relationship was found between the ultrafiltration value and the dynamics of rate in E peak ( D E, r=0.45; p=0.02). Hemodialysis resulted in a reliable decrease of potassium and sodium and increase of calcium in blood serum, the electrolyte dynamics being not associated with the dynamics of the parameters of transmitral blood flow. CONCLUSION. The data obtained suggest a demonstrable influence of a hemodialysis session on the diastolic filling of the left ventricle. The early diastolic filling considerably decreased which had a direct association with ultrafiltration. Patients with the ultrafiltration value more than 3% of the body mass were found to have considerably more demonstrable changes in transmitral blood flow.

1. Беленков ЮН, Агеев ФТ, Мареев ВЮ. Знакомьтесь: диастолическая Сердечная недостаточность. Сердечная недостаточность 2000; 1: 40-44.

2. Терещенко CH, Демидова ИВ, Александрия ЛГ, Агеев ФТ. Диастолическая дисфункция левого желудочка и ее роль в развитии хронической сердечной недостаточности. Сердечная недостаточность 2000; 2: 61-65.

3. Рекомендации по диагностике и лечению хронической сердечной недостаточности. Доклад экспертной группы по диагностике и лечению хронической сердечной недостаточности Европейского общества кардиологов. Сердечная недостаточность 2001; 6: 251-276.

4. Thomas JT, Kelly RF, Thomas SJ et al. Utility of history, physical examination electrocardiogram, and chest radiograph for differentiating normal from decreased systolic function in patients with heart failure. Am J Med 2002; 112: 437-445.

5. Овчинников АГ, Агеев ФТ, Мареев ВЮ. Методические аспекты применения допплерэхокардиографии в диагностике диастолической дисфункции левого желудочка. Сердечная недостаточность 2000; 2: 66-70.

6. Punzengruber С, Wallner М. Doppler echocardiographic analysis of diastolic left ventricular function to intradialytic hypotension. Klin Wochenschr 1989; 67: 826-832.

7. Ruffmann K, Mandelbaum A, Bommer J et al. Doppler echocardiographic findings in dialysis patients. Nephrol Dial Transplant 1990; 5: 426-431.

8. European Study Group on Diastolic Heart Failure. How to Diagnose Diastolic Heart Failure. Eur Heart J 1998; 19: 990-1003.

9. Schreiber MJ. Jr Clinical case-based approach to understanding intradialytic hypotension. Am J Kidney Dis 2001; 38 [Suppl 4]: S37-47.

10. Cai Y, Zimmerman A, Ladefoged S, Secher NH. Can haemodialysis-induced hypotension be predicted? Nephron 2002;92:582-588.

11. Sahn DJ, DeMaria A, Kissio J, Weyman A. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 1978; 58: 1072-1083.

12. Schiller NB, Shan PM, Crawford M et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. J Am Soc Echocardiogr 1989; 2:358-367.

13. Devereux RB, Alomso DR, Lutas EM et al. Echocardiographic assessment of left ventricular hypertrophy comparison to necropsy findings. Am J Cardiol 1986; 57: 450-458.

14. Abergel E, Tase M, Bohlader J. Which definition for echocardiographic left ventricular hypertrophy? Am J Cardiol 1995;75:486-503.

15. Ganau A, Devereux RB, Roman MJ et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol 1992; 19: 1550-1558.

16. Thomson GE, Waterhouse K, McDonald HPJ1 Friedman EA. Hemodialysis for chronic renal failure. Arch Intern Med 1967; 120:153-167.

17. Schumacher J, Rob P, Kreft B et al. Measurement of fluid volume shifts during hemodialysis by M-mode ultrasonography. Blood Purif 2000; 18: 103-109.

18. Родин ИН. Инструментальное определение «сухого веса» и оптимального объема ультрафильтрации у больных в условиях лечения программным гемодиализом. Нефрология и диализ 2002; 1:41 -44.

19. Енькина TH, Лукичев БГ, Енькин AA, Гринев КМ. Влияние шунтового кровотока по артериовенозной фистуле на развитие сердечной недостаточности у больных с хронической почечной недостаточностью, корригированной программным гемодиализом. Нефрология 2000; 1: 48-52.

20. Cohen Gl, Pietrolungo JF, Thomas JD, Klein AL. А practical guide to assessment of ventricular diastolic function using Doppler echocardiography. J Am Coll Cardiol 1996; 27: 1753-1760.

21. Nijland F, Kamp O, Karreman AJP et al. Prognostic implications of restrictive left ventricular filling in acute myocardial infarction: A serial Doppler echocardiographic study. J Am Coll Cardiol 1997; 30: 1618-1624.

22. Pozzoli M, Traversi E, Coiffi G et al. Loading manipulations improve the prognostic value of Doppler evaluation of mitral flow in patients with chronic heart failure. Circulation 1997; 95: 1222-1230.