title: Echocardiographic findings in long-term, long-hour hemodialysis patients.
abstract: This article describes the echocardiographic structural and functional findings in a cohort of 30 patients on ten or more years of uninterrupted long-hour (24 hours per week dialysis schedule) hemodialysis (mean duration 187.7 months, range 120 to 299 months). Cardiac structural analysis was remarkable for the prevalence of LVH (76%), very rarely asymmetric (3%). Hemoglobin and (log) plasma renin activity were determinants of the LV wall thickness ratio (r = -0.57 and 0.54, p = 0.003 and 0.044 respectively). Markers of systolic contractile function were frequently normal (100% MVCFS; 85% FSI). Diastolic ventricular compliance was abnormal in 59% of patients. Blood pressure history appeared important in determining LVH, but office/ABPM measures of BP were not. Patients after parathyroidectomy (PTx) had a smaller LVPWTN (8.68 mm/m2 without PTx cf 7.01 mm/m2 after PTx, p = 0.036). Left ventricular cavity size was rarely enlarged (10%), with hemoglobin (r = -0.47, p = 0.012) and PTH (r = -0.65, p < 0.001) the major determinants of EDDN. Left atrial diameter was increased in 77% of patients. Cardiac valvular calcification was seen in 50% of patients. Our findings show that despite good BP control without recourse to antihypertensive drugs, LVH with good LV systolic function is very common in these long-survivors.
authors.affiliation: Withington Hospital Artificial Kidney Unit, Withington Hospital, Manchester, UK.
authors.forename: A
authors.initials: A
authors.lastname: Covic
authors.forename: D J
authors.initials: DJ
authors.lastname: Goldsmith
authors.forename: G
authors.initials: G
authors.lastname: Georgescu
authors.forename: M C
authors.initials: MC
authors.lastname: Venning
authors.forename: P
authors.initials: P
authors.lastname: Ackrill
mesh_terms: D001021:Aortic Valve / Q000000981:diagnostic imaging; D001794:Blood Pressure / Q000502:physiology; D018660:Blood Pressure Monitoring, Ambulatory; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D004452:Echocardiography; D006437:Hemodialysis, Home; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008943:Mitral Valve / Q000000981:diagnostic imaging; D009200:Myocardial Contraction / Q000502:physiology; D015995:Prevalence; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology