title: Left Atrial Dysfunction in End-Stage Renal Disease Patients Treated by Hemodialysis.
abstract: BACKGROUND
  Repeated inter-dialysis water retention contributes to the development of left ventricular hypertrophy and failure, which is responsible for significant mortality of end-stage renal disease (ESRD) patients. The left atrium has a thin wall, which makes it even more prone to preload changes. In the general population with heart failure with preserved ejection fraction (HFpEF), left atrial function is even worse than that in patients with reduced ejection fraction. We hypothesized that repeated water retention is related to left atrial dysfunction in ESRD patients treated by hemodialysis and that the expected changes would be related to the brain natriuretic peptide (BNP) levels.
  
  
  METHODS
  Forty six patients were enrolled. Left atrial end-diastolic and end-systolic volumes and left atrial ejection fraction (LAEF) were recorded by echocardiography just before and just after dialysis and then analyzed offline. Moreover, BNP was analyzed also prior to dialysis and after. Effects of dialysis were tested using paired t test and the correlation analysis was applied to test associations.
  
  
  RESULTS
  LAEF was inversely related to the dialysis vintage (r = -0.62, p = 0.001) and patient's age (r = -0.48, p = 0.005) and it did not increase after dialysis despite the decrease of left atrial volume. BNP was related to left atrial volume index (r = 0.45, p = 0.019) and to LAEF (r = -0.57, p = 0.003).
  
  
  CONCLUSIONS
  LAEF is decreased especially in long-term dialyzed patients and does not improve after dialysis despite the decrease of left atrial volume. Inadequate contractility reserve of the left atrium is similar to the non-ESRD patients with HFpEF and might help explain the high prevalence of heart failure in ESRD patients.
authors.affiliation: 3rd Department of Internal Medicine,First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Malik
authors.forename: Jana
authors.initials: J
authors.lastname: Lachmanova
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Kudlicka
authors.forename: Katarina
authors.initials: K
authors.lastname: Rocinova
authors.forename: Anna
authors.initials: A
authors.lastname: Valerianova
authors.forename: Magdalena
authors.initials: M
authors.lastname: Bartkova
authors.forename: Vladimir
authors.initials: V
authors.lastname: Tesar
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006325:Heart Atria / Q000503:physiopathology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis