Echocardiographic Evaluation of Cardiac Dysfunction in Hemodialysis Patients with or without Intradialytic Hypertension

Siam, Mohamed Ahmed; Allam, Emad Mohamed; Al-Adl, Ahmed Salama; Abd Elkader, Tamer Mohamed; Byomy, Marwa Ahmed

doi:10.21608/ijma.2023.177195.1562

Echocardiographic Evaluation of Cardiac Dysfunction in Hemodialysis Patients with or without Intradialytic Hypertension

Document Type : Original Article

Authors

¹ Department of Internal Medicine, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt

² Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

³ Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

10.21608/ijma.2023.177195.1562

Abstract

Background: Intradialytic hypertension [IDH] is an increase in systolic blood pressure [SBP] of more than 10 mm Hg over pre-dialysis SBP, which is a serious consequence of hemodialysis [HD]. Evaluation of IDH-related cardiac dysfunction in HD patients, such as left ventricular hypertrophy [LVH] or pulmonary hypertension [PHTN], may be performed using an echocardiogram, a non-invasive technique.
Objective: This study aimed to evaluate the characteristics of IDH in patients undergoing maintenance HD and the echocardiographic findings in patients with IDH.
Patients and methods: A case-control study was conducted for seven months on 60 patients with end-stage renal disease in Al-Azhar University Hospital, Egypt. The study included adult patients on regular dialysis for more than three months and excluded patients with unstable health conditions. Data were collected through a full history, clinical examination, laboratory tests, and echocardiographic assessments and analyzed using statistical methods such as T-test, ANOVA, and the Chi-square test.
Results: The study showed a statistically significant reduction in left ventricular end-systolic diameter [LVESD], left ventricular end-diastolic diameter [LVEDD], left atrial volume index [LAVI], and pulmonary artery systolic pressure [PASP] in patients with IDH [p<0.05]. The reduction in LVESD was from 43.67 ± 3.26 to 42.17 ± 3.03 mm, in LVEDD from 59.6 ± 2.04 to 58.07 ± 3.93 mm, in LAV from 34.67± 2.3 to 31.9 ± 2.04 mm³, and in PASP from 42.33 ± 6.7 to 40.93 ± 6.84 mmHg.
Conclusion: Poorly managed BP in HD patients is linked to volume overload, increasing the risk of diastolic dysfunction and subsequent heart failure. HD patients with IDH had substantial reductions in LVEDD, LVESD, and PASP after HD sessions.

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