Effects of Standard and Individualized Dialysate Sodium in Chronic Hemodialysis Patients Upon Echocardiography Parameters.

Aims: This study assessed the effects of individualized dialysis sodium prescription on changes of echo-cardiography in hemodialysis (HD) patients. Methods: 77 chronic hemodialysis patients were analysed. In the first phase all patients underwent dialysis with standard dialysate sodium of 138 mmol/L followed by the second phase where dialysis was performed with individualized dialysate sodium concentration according to average pre HD serum sodium concentration. After the first phase, the subjects were divided into 3 groups: normotensive, hypertensive and hypotensive based on the average pre-HD systolic BP during the first phase. In all patients echocardiography was performed at the end of the first and second phase. Results: Patients had no statistical significant change in blood pressure compared with standard dialysate sodium, only statistical significant change in interdialytic weight gain (IDWG). By dividing the patients, sodium individualization resulted in significantly lower blood pressure and IDWG (p=0.018) in hyper-tensive patients, whereas normotensive patients showed only significant decrease in IDWG (p=0,004). Hypertensive patients had significant highest sodium gradient compared to other patients (p<0.05), followed by significant increase of 0,6% IDWG confirmed with univariate regression analysis. In all patients, echocardiography analysis showed an increase of 2.04 mm of LVDD by increasing the sodium gradient for 1 mmol/L and significantly increased LVM of 35.69 gr by 1 kg increase in IDWG. Conclusions: A reduction of the dialysate sodium concentration based on the pre HD serum sodium level of the patient, reduced the SBP, DBP and IDWG and decreased the volume overload upon the heart and consequently heart hypertrophy assessed by echocardiography.

Cardiovascular Comorbidity in Patients with Chronic Obstructive Pulmonary Disease: Echocardiography Changes and Their Relation to the Level of Airflow Limitation.

AIM: To compare the frequency of echocardiographic changes in patients with chronic obstructive pulmonary disease (COPD) and non-COPD controls and to assess their relation to the level of airflow limitation. METHODS: Study population included 120 subjects divided into two groups. Group 1 included 60 patients with COPD (52 male and 8 females, aged 40 to 80 years) initially diagnosed according to the actual recommendations. Group 2 included 60 subjects in whom COPD was excluded serving as a control. The study protocol consisted of completion of a questionnaire, pulmonary evaluation (dyspnea severity assessment, baseline and post-bronchodilator spirometry, gas analyses, and chest X-ray) and two dimensional (2D) Doppler echocardiography. RESULTS: We found significantly higher mean right ventricle end-diastolic dimension (RVEDd) in COPD patients as compared to its dimension in controls (28.0 ± 4.8 mm vs. 24.4 ± 4.3 mm; P = 0.0000). Pulmonary hypertension (PH) was more frequent in COPD patients than in controls (33.3% vs. 0%; P = 0.0004) showing a linear relationship with the severity of airflow limitation. The mean value of left ventricular ejection fraction (LVEF%) was significantly lower in COPD patients than its mean value in controls (57.4 ± 6.9% vs 64.8 ± 2.7%; P = 0.0000) with no correlation with severity of airflow limitation. CONCLUSION: Frequency of echocardiographic changes in COPD patients was significantly higher as compared to their frequency in controls in the most cases being significantly associated with the severity of airflow limitation. Echocardiography enables early, noninvasive, and accurate diagnosis of cardiac changes in COPD patients giving time for early intervention.