title: Echocardiographic Parameters During Long and Short Interdialytic Intervals in Hemodialysis Patients.
abstract: BACKGROUND
  The long interdialytic interval in thrice-weekly hemodialysis is associated with excess cardiovascular risk. However, the mechanisms behind these adverse consequences are not fully understood. This study investigated the interdialytic changes in right and left ventricular function during the 2- and 3-day intervals.
  
  
  METHODS
  Observational study with 2 random crossover sequences of recordings: 3-day followed by 2-day interval or vice versa.
  
  
  METHODS
  41 stable patients with end-stage renal disease on standard thrice-weekly hemodialysis therapy.
  
  
  METHODS
  3-day (long) versus 2-day (short) interdialytic interval.
  
  
  RESULTS
  Interdialytic change in echocardiographic indexes of left and right ventricular function.
  
  
  METHODS
  2-dimensional echocardiographic and tissue Doppler imaging studies were performed with a Vivid 7 cardiac ultrasound system at the start and end of the 3- and 2-day interdialytic intervals.
  
  
  RESULTS
  During both intervals studied, elevations in cardiac output, stroke volume, left ventricular mass index, and peak early diastolic velocities of the left ventricle were evident. Interdialytic weight gain (3.0±1.7 vs 2.4±1.3 [SD] kg) and inferior vena cava diameter increase (0.54±0.3 vs 0.25±0.3) were higher during the 3-day versus the 2-day interval (P<0.001). Left ventricular systolic and diastolic function indexes were generally no different between interdialytic intervals. In contrast, interdialytic increases in left and right atrial volume, right ventricular systolic pressure (RVSP; 15.3±10.2 vs 4.7±5.2mmHg; P<0.001), and tricuspid regurgitation maximum velocity (0.46±0.45 vs 0.14±0.33m/s; P=0.001) were significantly greater during the 3- versus the 2-day interval. Multivariable analysis suggested that changes in interdialytic weight gain, right ventricle diastolic function, and pulmonary vascular resistance were determinants of the change in RVSP.
  
  
  CONCLUSIONS
  Observational study design.
  
  
  CONCLUSIONS
  Excess volume accumulation over the long interdialytic interval in hemodialysis patients results in higher left and right atrial enlargement and RVSP elevation, which clinically corresponds to pulmonary circulation overload, providing one plausible pathway for the excess mortality risk during this period.
authors.affiliation: 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tsilonis
authors.affiliation: Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. Electronic address: psarafidis11@yahoo.gr.
authors.forename: Pantelis A
authors.initials: PA
authors.lastname: Sarafidis
authors.affiliation: 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Vasilios
authors.initials: V
authors.lastname: Kamperidis
authors.affiliation: Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Charalampos
authors.initials: C
authors.lastname: Loutradis
authors.affiliation: Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Panagiotis I
authors.initials: PI
authors.lastname: Georgianos
authors.affiliation: Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Imprialos
authors.affiliation: 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Antonios
authors.initials: A
authors.lastname: Ziakas
authors.affiliation: 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Sianos
authors.affiliation: Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Pavlos
authors.initials: P
authors.lastname: Nikolaidis
authors.affiliation: Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Anastasios N
authors.initials: AN
authors.lastname: Lasaridis
authors.affiliation: 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Haralambos
authors.initials: H
authors.lastname: Karvounis
mesh_terms: D018592:Cross-Over Studies; D003971:Diastole; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D013599:Systole; D013997:Time Factors
keywords: Long interdialytic interval; atrial enlargement; cardiovascular risk; echocardiography; end-stage renal disease (ESRD); hemodialysis; pulmonary circulation overload; right ventricular systolic pressure (RVSP); volume excess