title: Effect of fluid loading on left ventricular volume and stroke volume variability in patients with end-stage renal disease: a pilot study.
abstract: OBJECTIVE
  The aim of this study was to investigate fluid loading-induced changes in left ventricular end-diastolic volume (LVEDV) and stroke volume variability (SVV) in patients with end-stage renal disease (ESRD) using real-time three-dimensional transesophageal echocardiography and the Vigileo-FloTrac system.
  
  
  METHODS
  After obtaining ethics committee approval and informed consent, 28 patients undergoing peripheral vascular procedures were studied. Fourteen patients with ESRD on hemodialysis (HD) were assigned to the HD group and 14 patients without ESRD were assigned to the control group. Institutional standardized general anesthesia was provided in both groups. SVV was measured using the Vigileo-FloTrac system. Simultaneously, a full-volume three-dimensional transesophageal echocardiography dataset was acquired to measure LVEDV, left ventricular end-systolic volume, and left ventricular ejection fraction. Measurements were obtained before and after loading 500 mL hydroxyethyl starch over 30 minutes in both groups.
  
  
  RESULTS
  In the control group, intravenous colloid infusion was associated with a significant decrease in SVV (13.8%±2.6% to 6.5%±2.6%, P<0.001) and a significant increase in LVEDV (83.6±23.4 mL to 96.1±28.8 mL, P<0.001). While SVV significantly decreased after infusion in the HD group (16.2%±6.0% to 6.2%±2.8%, P<0.001), there was no significant change in LVEDV.
  
  
  CONCLUSIONS
  Our preliminary data suggest that fluid responsiveness can be assessed not by LVEDV but also by SVV due to underlying cardiovascular pathophysiology in patients with ESRD.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Kanda
authors.affiliation: Department of Anatomy, The Jikei University Graduate School of Medicine, Minato-ku, Tokyo, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Hirasaki
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Iida
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
authors.forename: Megumi
authors.initials: M
authors.lastname: Kanao-Kanda
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Toyama
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kunisawa
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Iwasaki
keywords: end-stage renal disease; goal-directed fluid therapy; hemodialysis; stroke volume variability; three-dimensional transesophageal echocardiography