[Association between cardiac function and intradialytic hypotension].

ABSTRACT

OBJECTIVE: To prospectively determinate the association of left ventricular systolic and diastolic function with intradialytic hypotension (IDH) in patients on maintenance hemodialysis. METHODS: Totally 115 patients with sinus rhythm were included in this study and divided into IDH group (n=29) and control group (n=86). The cardiac function was assessed by New York Heart Association (NYHA) classification before hemodialysis. Echocardiograms were performed in the next day after hemodialysis and the software of GE EchoPAC was used to estimate parameters of cardiac systolic and diastolic functions including ejection fraction, fractional shortening of left ventricular diameter, stroke volume (SV), cardiac output (CO), left ventricular mass index, Tei index, isovolumetric relaxation time, E-deceleration time, mitral inflow peak early diastolic velocity (E) to late diastolic velocities (A) ratio, and E to peak mitral annulus velocity (E/Em) ratio. RESULTS: The mean age (p=0.045) and the ratio of heart failure evaluated by the NYHA classification (p<0.01) were significantly higher in IDH group than those in control group. No difference was noted for gender, body mass index, duration of dialysis, body weight elevated rate and blood pressure between these two groups (all p>0.05). Left ventricular diameters at the end of diastolic phase, SV, and CO in IDH group were significantly lower than those in control group (all P<0.05), whereas no significant difference was found for EF, FS, Tei index, IVRT, EDT, E/A and E/Em ratio (all p>0.05). Multivariate logistic regression analysis showed that NYHA cardiac function was an independent predictor of IDH, and the risk of IDH increased by 1.134 times with incremental one grade of NYHA classification. CONCLUSIONS: IDH is a common complication of hemodialysis. Neither systolic dysfunction nor diastolic dysfunction of left ventricle evaluated in second day after hemodialysis affects its frequency, whereas the clinical cardiac function is an independent predictor of IDH.