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Changes in Right Ventricular Pressures Between Hemodialysis Sessions Recorded by an Implantable Hemodynamic Monitor

https://doi.org/10.1016/j.amjcard.2008.08.038Get rights and content

Intermittent and chronic volume overload might contribute to the onset and progression of cardiovascular disease in patients who are undergoing maintenance hemodialysis (HD). Continuous monitoring of central hemodynamic variables may provide valuable information to improve volume control, particularly in patients with left ventricular dysfunction. Sixteen patients with end-stage renal disease who were undergoing long-term HD received an implantable hemodynamic monitor consisting of a subcutaneously implanted memory device and transvenous right ventricular (RV) lead with a pressure sensor. The implantable hemodynamic monitor continuously records heart rate, RV pressures, and estimated pulmonary arterial (PA) diastolic pressure, an estimate of left ventricular filling pressure. All patients underwent HD 3 times per week, and averages of rest hemodynamic values from the first, second, and third nights after HD during 12 weeks were analyzed. The third night always occurred after the weekend, when there was an extended interval between dialysis sessions. From the first night to the second night, RV systolic pressure increased by 10 ± 8% (p <0.001), and estimated PA diastolic pressure increased by 16 ± 14% (p <0.001). On the third night, RV systolic pressure increased by 14 ± 12% (p <0.001), and estimated PA diastolic pressure increased by 23 ± 18% (p <0.001) compared with the first night. In conclusion, the progressive pressure increments between dialysis sessions seen in this study suggest that the implantable hemodynamic monitor was a sensitive indicator for changes in volume load in patients who were undergoing HD treatment. The results also suggest that more frequent dialysis may avoid excessive pressure increase, but this needs to be investigated further in future studies.

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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This study was supported by grants from the Swedish Heart and Lung Foundation, Stockholm, Sweden, and by Medtronic, Inc., Minneapolis, Minnesota.

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.

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