Differing myocardial response to a single session of hemodialysis in end-stage renal disease with and without type 2 diabetes mellitus and coronary artery disease.
BACKGROUND
Though hemodialysis (HD) acutely improves cardiac function, the impact of background diseases like coronary artery disease (CAD) and Type 2 diabetes (DM) in the setting of end-stage renal disease (ESRD) is not known. Tissue velocity echocardiography (TVE) offers a fast choice to follow changes in myocardial function after HD in ESRD with concomitant DM and /or CAD.


METHODS
46 subjects (17 with ESRD, Group 1; 15 with DM, Group 2; 14 with DM+CAD, Group 3) underwent standard and TVE prior to and shortly after HD. Besides standard Doppler variables, regional myocardial systolic and diastolic velocities, as well as systolic strain rate were post processed.


RESULTS
Compared with pre-HD, post-HD body weight (kg) significantly decreased in all the three groups (51 +/- 9 vs. 48 +/- 8, 62 +/- 10 vs.59 +/- 10, and 61 +/- 9 vs. 58 +/- 9 respectively; all p < 0.01). Left ventricular end diastolic dimensions (mm) also decreased post- HD (46 +/- 5 vs. 42 +/- 7, 53 +/- 7 vs. 50 +/- 7, 51 +/- 7 vs. 47 +/- 8 respectively; all p < 0.01). Regional longitudinal peak systolic velocity in septum (cm/s) significantly increased post-HD in Group 1(5.7 +/- 1.6 vs. 7.2 +/- 2.3; p < 0.001) while remained unchanged in the other two groups. Similar trends were noted in other left ventricular walls. When the myocardial velocities (cm/s) were computed globally, the improvement was seen only in Group 1 (6.3 +/- 1.5 vs. 7.9 +/- 2.0; p < 0.001). Global early regional diastolic velocity (cm/s) improved in Group 1, remained unchanged in Group 2, while significantly decreased in Group 3(-5.9 +/- 1.3 vs. -4.1 +/- 1.8; p < 0.01). Global systolic strain rate (1/sec) increased in the first 2 Groups but remained unchanged (-0.87 +/- 0.4 vs. -0.94 +/- 0.3; p = ns) in Group 3.


CONCLUSIONS
A single HD session improves LV function only in ESRD without coexistent DM and/or CAD. The present data suggest that not only dialysis-dependent changes in loading conditions but also co-existent background diseases determine the myocardial response to HD.
Govind
Satish Chandra
SC
Karolinska University Hospital at Huddinge, Stockholm, Sweden. satish.govind@ki.se
Roumina
Simin
S
Brodin
Lars-Ake
LA
Nowak
Jacek
J
Ramesh
Saligrama Srinivasiah
SS
Saha
Samir Kanti
SK
D000328:Adult; D000704:Analysis of Variance; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D016277:Ventricular Function, Left