title: Non invasive evaluation of cardiac hemodynamics in end stage renal disease (ESRD).
abstract: OBJECTIVE
  Volume overload is typical of haemodialysis patients; correct volume status evaluation is crucial in achieving blood pressure homeostasis, hypertension management and good treatment planning. This study evaluates the effect of acute volume depletion on ultrasonographic parameters and suggests two of them as able to predict patients volume overload.
  
  
  METHODS
  27 patients with end stage renal disease treated with haemodialysis underwent a complete echocardiographic exam before, after 90 min and at the end of the dialysis.
  
  
  RESULTS
  Blood pressure levels significantly drop during the first 90 min of dialysis (139 ± 20 vs 126 ± 18; p < 0.0001), reaching a steady state with significantly lower values compared to baseline (130 ± 28; p = 0.02). LV and left atrial volume significantly decreased (baseline vs end dialysis 98 ± 32 vs 82 ± 31 p = 0.003 and 28 ± 10 vs. 21 ± 9 cc/m(2) p < 0.001). A significant reduction of systolic function (EF 61.6 % ± 9 vs 58.7 % ± 9 p = 0.04), of diastolic flow velocities (E/A 1.13 ± 0.37 vs. 0.87 ± 0.38 p < 0.001) and mitral annulus TDI tissue velocity (i.e. E' lat 10.6 ± 3 vs. 9.4 ± 3 cm/s; p 0.0001) were observed. Stroke work (SW) and LV end-diastolic diameter (LVEDd) indexed to height 2.7(LVEDdi) were able to predict volume overload: cut off values of respectively 13.5 mm/m(2.7) for LVEDdi and 173 cJ for SW were able to predict with a specificity of 100 % the presence of a volemic overload of at least 4 %.
  
  
  CONCLUSIONS
  Blood pressure, cardiac morphology and function are significantly modified by acute volume depletion and such variations are strictly interrelated. SW and LVEDd/height(2.7) may identify ESRD patients carrying an higher volume load.
authors.affiliation: Department of Medical Sciences, Division of Internal Medicine, Hypertension Unit, University Hospital 'S. Giovanni Battista', Turin, Italy, alberto.milan@unito.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Milan
authors.forename: Eleonora
authors.initials: E
authors.lastname: Avenatti
authors.forename: Erika
authors.initials: E
authors.lastname: Della Valle
authors.forename: Ambra
authors.initials: A
authors.lastname: Fabbri
authors.forename: Agnese
authors.initials: A
authors.lastname: Ravera
authors.forename: Marco
authors.initials: M
authors.lastname: Pozzato
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ferrari
authors.forename: Francesco
authors.initials: F
authors.lastname: Quarello
authors.forename: Franco
authors.initials: F
authors.lastname: Aprà
authors.forename: Franco
authors.initials: F
authors.lastname: Veglio
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D004452:Echocardiography; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012680:Sensitivity and Specificity