Effect of preload reduction by haemodialysis on doppler indices of diastolic function in patients with end-stage renal disease.
OBJECTIVE
To assess the influence of preload reduction by haemodialysis on Doppler echocardiographic indices of cardiac diastolic function.


METHODS
Parameters of left ventricular diastolic function were measured in patients with end-stage renal disease before and after a single session of haemodialysis. Patients with valvular heart disease, coronary artery disease, cardiomyopathies, pericardial disease and those not in sinus rhythm were excluded from the study.


RESULTS
Seventeen subjects (12 males and 5 females, mean age 48 +/- 16 years) were studied. Over the duration of 3.7 +/- 0.6 hours of haemodialysis, 2.6 +/- 1.3 litres of ultrafiltrate was removed. The comparison of pre and post haemodialysis peak mitral E and A velocities showed a decrease in E velocity (p < 0.01) whereas the change in A velocity was not significant. The E/A ratio decreased significantly (p < 0.05).The decrease in E velocity correlated well with the amount of ultrafiltrate (r = 0.653, p < 0.01). There was a significant increase in isovolumetric relaxation time (p< 0.05) whereas deceleration time did not change (p =0.3).


CONCLUSIONS
Ultrafiltration during haemodialysis causes a rapid reduction in preload. It results in decreased early left ventricular diastolic filling without a change in the atrial phase of filling, hence causing a decrease in calculated E/A ratio.
Acharya
P
P
Department of Internal Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal. acharya.pramod@gmail.com
Ranabhat
K
K
Trikhatri
Y
Y
Manandhar
D N
DN
Sharma
S K
SK
Karki
P
P
D000328:Adult; D000368:Aged; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006440:Hemofiltration; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D018487:Ventricular Dysfunction, Left / Q000517:prevention & control*; D055815:Young Adult