title: Improved left ventricular contractility with cool temperature hemodialysis.
abstract: Cool temperature dialysis (CTD) has been shown to sharply decrease the frequency of intradialytic hemodialysis hypotension, but the mechanism of this hemodynamic protection is unknown. Therefore, we performed two-dimensional echocardiographic studies of left ventricular contractility in six stable hemodialysis patients before and after hemodialysis at 37 degrees C (RTD) and 35 degrees C (CTD). Left ventricular function was assessed by plotting the rate-corrected velocity of circumferential fiber shortening (Vcfc) against end-systolic wall stress (sigma es) at four different levels of afterload. Linear regression was used to calculate Vcfc at a common afterload of 50 g/cm2. Changes in weight and dialysis parameters were similar following RTD and CTD. Mean arterial pressure and heart rate did not change significantly following RTD or CTD. The Vcfc - sigma es relation was shifted upward in each patient after CTD, indicating increased contractility as compared to RTD or pre-dialysis baseline. Pre-dialysis Vcfc at an afterload of 50 g/cm2 was similar during RTD and CTD (0.94 +/- 0.24 circ/sec vs. 0.92 +/- 0.22 circ/sec). Postdialysis Vcfc at an afterload of 50 g/cm2 was significantly higher for CTD than for RTD (1.13 +/- 0.29 circ/sec vs. 0.98 +/- 0.30 circ/sec, P = 0.0004). Thus, cool temperature dialysis increases left ventricular contractility in hemodialysis patients, which may be a potential mechanism whereby hemodynamic tolerance to the dialysis procedure is improved.
authors.affiliation: Department of Internal Medicine, Veterans Affairs Medical Center, Dallas, Texas.
authors.forename: F L
authors.initials: FL
authors.lastname: Levy
authors.forename: P A
authors.initials: PA
authors.lastname: Grayburn
authors.forename: C J
authors.initials: CJ
authors.lastname: Foulks
authors.forename: M E
authors.initials: ME
authors.lastname: Brickner
authors.forename: W L
authors.initials: WL
authors.lastname: Henrich
mesh_terms: D000328:Adult; D000368:Aged; D003080:Cold Temperature; D006439:Hemodynamics; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D006435:Renal Dialysis / Q000379:methods*; D016277:Ventricular Function, Left