title: Left-ventricular diastolic dysfunction as a risk factor for dialytic hypotension.
abstract: OBJECTIVE
  Intradialytic hypotension may adversely affect the outcome of chronic hemodialysis and thus reduce the patients' life expectancy. The aim of this study was to assess the link between left-ventricular diastolic dysfunction and dialytic hypotension.
  
  
  METHODS
  We performed a prospective cross-sectional study of 72 hemodialysis patients with a low dialysis vintage, 36 of whom had dialysis hypotension, based on echocardiography and brain natriuretic peptide (BNP) assay.
  
  
  RESULTS
  There was no difference between normotensive patients and those with dialysis-associated chronic hypotension as regards BNP level, cardiac index, left-ventricular ejection fraction, or myocardial fractional shortening. Both hypotension-prone patients requiring dialysate sodium profiling and chronic refractory hypotensive patients requiring macromolecule infusion had cardiac diastolic dysfunction as shown by a similarly abnormal E/A ratio <1 in 89-91% of cases, associated with a significant decrease in color M-mode diastolic flow propagation velocity (V(p), p < 0.05 nonparametric ANOVA). The area under the ROC curve for V(p) was 0.69. A V(p) cutoff of 39.5 cm/s was optimal for predicting dialysis-associated hypotension.
  
  
  CONCLUSIONS
  We conclude that diastolic dysfunction is associated with dialytic hypotension and that a low V(p)--a preload-independent index--is predictive of dialysis-associated hypotension.
authors.affiliation: Division of Nephrology and Dialysis, Centre Hospitalier Privé Claude Galien, Quincy-sous-Sénart, France. rostotom@orange.fr
authors.forename: Guy
authors.initials: G
authors.lastname: Rostoker
authors.forename: Mireille
authors.initials: M
authors.lastname: Griuncelli
authors.forename: Christelle
authors.initials: C
authors.lastname: Loridon
authors.forename: Abbès
authors.initials: A
authors.lastname: Benmaadi
authors.forename: Eric
authors.initials: E
authors.lastname: Illouz
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015897:Comorbidity; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D054144:Heart Failure, Diastolic / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology*
chemical_list: D020097:Natriuretic Peptide, Brain