PMID- 19237804
OWN - NLM
STAT- MEDLINE
DCOM- 20090428
LR  - 20161125
IS  - 1319-2442 (Print)
IS  - 1319-2442 (Linking)
VI  - 20
IP  - 2
DP  - 2009 Mar
TI  - The impact of left ventricular preload reduction on cardiac pulsed Doppler 
      indices during hemodialysis and its relation to intra-dialysis hypotension: a 
      pulsed Doppler study.
PG  - 201-7
AB  - Fluid status in the body plays an important role on left ventricular (LV) filling 
      in patients with end-stage renal disease (ESRD) on regular hemodialysis (HD), and 
      plays a role in intra-dialysis hemo-dynamic derangement. Fifty-two patients with 
      ESRD on regular HD, including 34 males with a mean age of 45.5 +/- 13 years 
      (range 18-72 years), were studied. All patients underwent Echo-pulsed Doppler 
      study before and immediately after a HD session. The Echo Doppler indices noted 
      were: LV cavity dimension and wall thickness, LV ejection fraction (LVEF%), 
      trans-mitral early diastolic filling velocity (E wave), atrial filling diastolic 
      velocity (A wave), E/A ratio, Deceleration Time (DT) of E wave, Isovolumic 
      relaxation time (IVRT), Aortic Velocity Integral (AVI) and Inferior Vena Cava 
      Diameter (VCD) at expiration. Patients were divided into two groups according to 
      the amount of net ultra filtrate loss after HD. Group I comprised of 25 patients 
      with fluid loss of > or = 2 liters. During the HD session, each patient was 
      observed for the development of acute clinical events such as arterial 
      hypotension (systolic BP less than 90 mmHg), chest pain and arrhythmias. There 
      was a significant difference between the two groups in the mean values, pre- and 
      post- HD, of reduction of E wave velocity (p< 0.01), the reduction of E/A ratio 
      (p< 0.05), the increment in DT of E wave (p< 0.05), the reduction in AVI (p< 
      0.01) and the reduction of VCD (p< 0.05). There was no significant difference 
      between the groups in the reduction of A wave velocity and the reduction of IVRT. 
      Among the study patients, 11 (21%) developed systolic hypo-tension during HD. The 
      pre-dialysis mean values of E/A ratio and DT of E wave in patients who developed 
      hypotension compared to those who did not was 0.7 +/- 0.2 vs 1.1 +/- 0.2.1 (p< 
      0.001) and 246 +/- 40 vs 224 +/- 34 msec (p< 0.05), respectively. Our study 
      suggests that preload reduction in patients with ESRD on regular HD is directly 
      proportional to the reduction of left ventricle early filling and prolongation of 
      Deceleration Time of E wave. The potential risk of intra-dialysis hypotension can 
      be predicted, if LV diastolic Pulse Doppler pre-dialysis E/A ratio is less than 
      0.7 and Deceleration Time of E wave is more than 246 msec. Careful assess-ment of 
      these patients is crucial to prevent hypotension, especially if a large preload 
      reduction is required.
FAU - Alarrayed, Sameer
AU  - Alarrayed S
AD  - Department of Nephrology, Salmanyia Medical Complex, Arabian Gulf University, 
      Manama, Bahrain. salarrayed@yahoo.com
FAU - Garadah, Taysir Said
AU  - Garadah TS
FAU - Alawdi, Abdulhai Ali
AU  - Alawdi AA
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - Saudi Arabia
TA  - Saudi J Kidney Dis Transpl
JT  - Saudi journal of kidney diseases and transplantation : an official publication of 
      the Saudi Center for Organ Transplantation, Saudi Arabia
JID - 9436968
SB  - IM
MH  - Cardiac Volume/*physiology
MH  - Diastole
MH  - Echocardiography, Doppler, Pulsed/*methods
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Ventricles/*diagnostic imaging/physiopathology
MH  - Humans
MH  - Hypotension/diagnostic imaging/etiology/*physiopathology
MH  - Kidney Failure, Chronic/complications/physiopathology/*therapy
MH  - Male
MH  - Middle Aged
MH  - *Renal Dialysis
MH  - Reproducibility of Results
MH  - Stroke Volume/physiology
MH  - Ventricular Function, Left/*physiology
EDAT- 2009/02/25 09:00
MHDA- 2009/04/29 09:00
CRDT- 2009/02/25 09:00
PHST- 2009/02/25 09:00 [entrez]
PHST- 2009/02/25 09:00 [pubmed]
PHST- 2009/04/29 09:00 [medline]
PST - ppublish
SO  - Saudi J Kidney Dis Transpl. 2009 Mar;20(2):201-7.