title: Intradialytic Cardiac Magnetic Resonance Imaging to Assess Cardiovascular Responses in a Short-Term Trial of Hemodiafiltration and Hemodialysis.
abstract: Hemodynamic stress during hemodialysis (HD) results in recurrent segmental ischemic injury (myocardial stunning) that drives cumulative cardiac damage. We performed a fully comprehensive study of the cardiovascular effect of dialysis sessions using intradialytic cardiac magnetic resonance imaging (MRI) to examine the comparative acute effects of standard HD versus hemodiafiltration (HDF) in stable patients. We randomly allocated 12 patients on HD (ages 32-72 years old) to either HD or HDF. Patients were stabilized on a modality for 2 weeks before undergoing serial cardiac MRI assessment during dialysis. Patients then crossed over to the other modality and were rescanned after 2 weeks. Cardiac MRI measurements included cardiac index, stroke volume index, global and regional contractile function (myocardial strain), coronary artery flow, and myocardial perfusion. Patients had mean±SEM ultrafiltration rates of 3.8±2.9 ml/kg per hour during HD and 4.4±2.5 ml/kg per hour during HDF (P=0.29), and both modalities provided a similar degree of cooling. All measures of systolic contractile function fell during HD and HDF, with partial recovery after dialysis. All patients experienced some degree of segmental left ventricular dysfunction, with severity proportional to ultrafiltration rate and BP reduction. Myocardial perfusion decreased significantly during HD and HDF. Treatment modality did not influence any of the cardiovascular responses to dialysis. In conclusion, in this randomized, crossover study, there was no significant difference in the cardiovascular response to HDF or HD with cooled dialysate as assessed with intradialytic MRI.
authors.affiliation: Sir Peter Mansfield Imaging Centre and.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Buchanan
authors.affiliation: Centre for Kidney Research and Innovation, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Azharuddin
authors.initials: A
authors.lastname: Mohammed
authors.affiliation: Sir Peter Mansfield Imaging Centre and.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Cox
authors.affiliation: Center of Excellence Medical Europe, Middle East and Africa, Fresenius Medical Care, Bad Homburg, Germany; and.
authors.forename: Katrin
authors.initials: K
authors.lastname: Köhler
authors.affiliation: Center of Excellence Medical Europe, Middle East and Africa, Fresenius Medical Care, Bad Homburg, Germany; and.
authors.forename: Bernard
authors.initials: B
authors.lastname: Canaud
authors.affiliation: Centre for Kidney Research and Innovation, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Maarten W
authors.initials: MW
authors.lastname: Taal
authors.affiliation: Centre for Kidney Research and Innovation, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Selby
authors.affiliation: Sir Peter Mansfield Imaging Centre and.
authors.forename: Susan
authors.initials: S
authors.lastname: Francis
authors.affiliation: Departments of Medicine and cmcint48@uwo.ca.|Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Canada.
authors.forename: Chris W
authors.initials: CW
authors.lastname: McIntyre
mesh_terms: D002319:Cardiovascular System / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D018592:Cross-Over Studies; D005260:Female; D017583:Hemodiafiltration; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D013997:Time Factors
keywords: cardiac MRI; hemodiafiltration; hemodialysis; myocardial stunning; randomized controlled trials