MiscellaneousChanges in Right Ventricular Pressures Between Hemodialysis Sessions Recorded by an Implantable Hemodynamic Monitor†
Section snippets
Methods
Sixteen patients with renal failure who were undergoing long-term intermittent HD treatment were implanted with IHMs. The study conformed to the principles outlined in the Declaration of Helsinki. The local ethics committee approved the protocol, and the patients gave their written consent to the study. All patients received dialysis treatment 3 times a week in a daycare dialysis hospital during the whole study period. HD was performed with bicarbonate dialysate on Gambro AK-200 (Gambro AB,
Results
Baseline patient characteristics and dialysis data are listed in Table 1. The reduced left ventricular ejection fraction and enlarged diastolic septal wall thickness indicate mild to moderate left ventricular dysfunction and hypertrophy. All patients except 1 were treated with ≥1 cardiovascular drugs. The study included only 1 woman. Two patients had preserved urine production. All patients had peripheral arteriovenous fistulas. Four weeks after implantation, 1 patient with cystic kidney
Discussion
The present study describes ambulatory hemodynamic values in patients with end-stage renal disease who were undergoing intermittent HD over a 12-week period. Hemodynamic measurements were collected continuously by an IHM. The study revealed that RV systolic pressure and estimated PA diastolic pressure, an estimation of left ventricular filling pressures, were normal or slightly elevated during the first night's rest after an HD treatment but increased to upper or above normal ranges after the
Acknowledgment
We would like to thank Helena Karlsson and David Ersgard for their expert assistance during patient visits and data collection.
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Cited by (19)
Proposal for a functional classification system of heart failure in patients with end-stage renal disease: Proceedings of the Acute Dialysis Quality Initiative (ADQI) XI workgroup
2014, Journal of the American College of CardiologyCitation Excerpt :In addition, because echocardiographic findings are a prerequisite for entry into the classification system, standardization of the collection and documentation of these echocardiographic data is imperative. Studies in patients undergoing dialysis that deployed continuous hemodynamic monitoring before, during, and after RRT with ultrafiltration have demonstrated that interdialytic volume accumulation results in increased pressures in the pulmonary artery and right ventricle (Fig. 2) (24,25). The proposed staging system accommodates the “tidal nature” of nonphysiological volume removal.
The impact of kidney transplantation on heart failure risk varies with candidate body mass index
2009, American Heart JournalCitation Excerpt :First, it has been demonstrated that dialysis imparts specific hemodynamic stressors that may predispose patients to adverse cardiac remodeling and subsequent HF. In a recent study using implantable hemodynamic monitoring, patients undergoing hemodialysis 3 times weekly were demonstrated to have significant increases in right ventricular and pulmonary artery pressures between dialysis sessions.23 Similarly, LV mass, LV myocardial interstitial edema, and LV intraventricular synchrony have been shown to adversely fluctuate between hemodialysis sessions, all potentially leading to negative cardiac remodeling and subsequent HF.24,25
Time to go home
2023, Journal of Renal CareInfrequent use of nighttime dialysis for emergency admission due to worsening heart failure in patients on maintenance hemodialysis
2022, Therapeutic Apheresis and Dialysis
This study was supported by grants from the Swedish Heart and Lung Foundation, Stockholm, Sweden, and by Medtronic, Inc., Minneapolis, Minnesota.
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Conflicts of interest: Dr Kjellström is an employee of the study sponsor. Dr Braunschweig is a consultant to the study sponsor. Dr Grandjean is an employee of the study sponsor. Dr Linde is a consultant to the study sponsor.