Echocardiographic Indices in Patients with End-Stage Renal Disease and Their Association with Hemodialysis-to-Hemodiafiltration Transfer: A Prospective Observational Study

• Published in: Medicina (Kaunas, Lithuania) Vol. 60; no. 9; p. 1537
• Main Authors: Domjanović Matetić, Josipa, Baković Kramarić, Darija, Domjanović Škopinić, Tea, Jeličić, Ivo, Borić Škaro, Dijana, Božić, Joško, Matetic, Andrija
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 20-09-2024; MDPI
• Subjects: Adult; Aged; Blood; Cardiomyocytes; Care and treatment; Chronic kidney failure; Cohort Studies; Complications and side effects; contemporary echocardiography; Dialyzers; Echocardiography; Echocardiography - methods; Ejection fraction; end-stage renal disease; Female; Filtration; Heart diseases; hemodiafiltration; Hemodiafiltration - methods; Hemodiafiltration - statistics & numerical data; Hemodialysis; Hospitals; Humans; Kidney diseases; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - physiopathology; Kidney Failure, Chronic - therapy; Male; Middle Aged; Mortality; Nephrology; Observational studies; Prevention; Prognosis; Prospective Studies; Renal Dialysis - adverse effects; Renal Dialysis - methods; Risk factors; Software; Croatia; United States > US; Germany; Chicago Illinois; hemodialysis; contemporary echocardiography; end-stage renal disease; hemodiafiltration
• ISSN: 1648-9144; 1010-660X; 1648-9144
• DOI: 10.3390/medicina60091537

: The assessment of cardiac function in patients with end-stage renal disease (ESRD) is vital due to their high cardiovascular risk. However, contemporary echocardiographic indices and their association with hemodialysis-to-hemodiafiltration transfer are underreported in this population.
: This prospective cohort study enrolled 36 ESRD patients undergoing hemodialysis-to-hemodiafiltration transfer, with baseline and 3-month post-transfer comprehensive echocardiographic assessments. The key parameters included the global work index, global constructed work, global wasted work (GWW), global work efficiency (GWE), and global longitudinal strain (GLS), with secondary measures from conventional echocardiography. The baseline measures were compared to general population reference values and changes pre- to post-transfer were analyzed using the Mann-Whitney U test.
: Patients exhibited significant deviations from reference ranges in GWW (179.0 vs. 53.0-122.2 mmHg%), GWE (90.0 vs. 53.0-122.2%), and GLS (-16.0 vs. -24.0-(-16.0)%). Post-transfer left ventricular myocardial work and longitudinal strain remained unchanged (
> 0.05), except for increased GWW (179.0, IQR 148.0-217.0 to 233.5, IQR 159.0-315.0 mmHg%,
= 0.037) and improved mid-inferior peak systolic longitudinal strain ((-17.0, IQR -19.0-(-11.0) to -18.7, IQR -20.0-(-18.0)%,
= 0.016). The enrolled patients also showed higher left atrial diameters, left ventricular volumes, and mass, with impaired systolic function in both ventricles compared to reference values.
: This study highlights baseline impairments in contemporary echocardiographic measures (GWW, GWE, GLS) in ESRD patients versus reference values, but found no association between hemodialysis-to-hemodiafiltration transfer and most myocardial work and strain parameters.