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The effect of hemodialysis on right ventricular functions in patients with end-stage renal failure

Keywords: End stage renal failure , hemodialysis , echocardiography , right ventricle , diastolic function

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Abstract:

Objective: The aim of this study was to evaluate the effects of hemodialysis (HD) on right ventricular echocardiographic parameters in patients with end-stage renal failure (ESRF). Methods: Forty-three uremic patients who underwent echocardiography before and 30 minutes after dialysis included in this prospective observational study. Right ventricular systolic function was evaluated using tricuspid annular plane systolic excursion (TAPSE) by M-mode echocardiography and tricuspid lateral annular systolic velocity (Sa) by tissue Doppler echocardiography whereas diastolic function was evaluated using tricuspid early (E) and late (A) diastolic flow velocities by conventional and tricuspid lateral annular early (Ea) and late (Aa) diastolic velocities by tissue Doppler echocardiography. Myocardial performance index was taken as an indicator of global functions. Paired t test or Wilcoxon test were used for statistical analysis where appropriate.Results: E decreased significantly (68±13 cm/s and 56±12 cm/s before and after HD, respectively; p<0.0001) but A did not (p=0.797).TAPSE was 1.84±0.34 cm before HD and showed a significant increase to 2.03±0.20 cm after HD (p=0.006). Right ventricular MPI, Sa and Aa did not change significantly by dialysis (p=0.504; p=0.118 and p=0.150 respectively) whereas Ea decreased to 8.8±2.5 cm/s from 11.3±3.4 cm/s (p<0.001). Ea/Aa ratio also decreased significantly to 0.69±0.35 from 0.84±0.44 with HD (p=0.007).Conclusion: The results of this study indicates that parameters of right ventricular systolic function such as Sa and MPI are independent of preload whereas the conventional and tissue Doppler parameters of right ventricular diastolic function are preload dependent in patients with end-stage renal failure who undergo regular hemodialysis.

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