Effect of preload reduction by haemodialysis on doppler indices of diastolic function in patients with end-stage renal disease.

OBJECTIVE: To assess the influence of preload reduction by haemodialysis on Doppler echocardiographic indices of cardiac diastolic function. METHODOLOGY: Parameters of left ventricular diastolic function were measured in patients with end-stage renal disease before and after a single session of haemodialysis. Patients with valvular heart disease, coronary artery disease, cardiomyopathies, pericardial disease and those not in sinus rhythm were excluded from the study. RESULTS: Seventeen subjects (12 males and 5 females, mean age 48 +/- 16 years) were studied. Over the duration of 3.7 +/- 0.6 hours of haemodialysis, 2.6 +/- 1.3 litres of ultrafiltrate was removed. The comparison of pre and post haemodialysis peak mitral E and A velocities showed a decrease in E velocity (p < 0.01) whereas the change in A velocity was not significant. The E/A ratio decreased significantly (p < 0.05).The decrease in E velocity correlated well with the amount of ultrafiltrate (r = 0.653, p < 0.01). There was a significant increase in isovolumetric relaxation time (p< 0.05) whereas deceleration time did not change (p =0.3). CONCLUSION: Ultrafiltration during haemodialysis causes a rapid reduction in preload. It results in decreased early left ventricular diastolic filling without a change in the atrial phase of filling, hence causing a decrease in calculated E/A ratio.