title: Changes in left ventricular diastolic function during hemodialysis sessions.
abstract: BACKGROUND
  Left ventricular diastolic dysfunction is common in hemodialysis patients and is associated with worse outcome. Previous studies have shown that diastolic function worsens from pre- to post-dialysis session, but this has not been studied during hemodialysis. We studied the evolution of diastolic function parameters early and late during hemodialysis.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  109 hemodialysis patients on a thrice-weekly dialysis schedule with a mean age of 62.5 ± 15.6 (SD) years were studied between March 2009 and March 2010.
  
  
  METHODS
  Hemodialysis with constant ultrafiltration rate and dialysate conductivity.
  
  
  RESULTS
  Changes in diastolic function parameters.
  
  
  METHODS
  Mitral early inflow (E) and tissue Doppler early diastolic velocity (mean e') were evaluated by echocardiography predialysis, at 60 and 180 minutes intradialysis, and postdialysis. Relative blood volume changes were calculated from changes in hematocrit.
  
  
  RESULTS
  Predialysis E and mean e' were 0.93 ± 0.24 m/s and 6.6 ± 2.1 cm/s, respectively. E and mean e' values decreased significantly during hemodialysis (P < 0.001). The steepest change occurred at 60 minutes intradialysis (E, -21.4% ± 17.6% and -30.5% ± 19.2% at 60 and 180 minutes, respectively; mean e', -16.0% ± 18.6% and -19.5% ± 21.8% at 60 and 180 minutes, respectively). At 60 minutes intradialysis, changes in relative blood volume and brain natriuretic peptide level were associated significantly with the change in E but not with the change in mean e'.
  
  
  CONCLUSIONS
  Changes in relative blood volume may not fully reflect central blood volume changes and do not capture the effect of blood loss to the extracorporal circuit. Left atrial volume was not measured.
  
  
  CONCLUSIONS
  Left ventricular diastolic function worsens early during a hemodialysis session. The decrease in mean e' at 60 minutes intradialysis was unrelated to changes in relative blood volume. Although this finding does not exclude a role of hypovolemia because of the limitations of the measurement of relative blood volume, it raises the possibility that non-volume-related mechanisms are involved in the early decrease in mean e' during hemodialysis.
authors.affiliation: Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Solmaz
authors.initials: S
authors.lastname: Assa
authors.forename: Yoran M
authors.initials: YM
authors.lastname: Hummel
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.forename: Johanna
authors.initials: J
authors.lastname: Kuipers
authors.forename: Henk
authors.initials: H
authors.lastname: Groen
authors.forename: Paul E
authors.initials: PE
authors.lastname: de Jong
authors.forename: Ralf
authors.initials: R
authors.lastname: Westerhuis
authors.forename: Casper F M
authors.initials: CF
authors.lastname: Franssen
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D001810:Blood Volume / Q000502:physiology; D003971:Diastole / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects / Q000639:trends*; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: Blood volume; cardiovascular disease; diastolic function; hemodialysis