Hemodialysis and hemodiafiltration differently modulate left ventricular diastolic function

• Published in: BMC nephrology 2013-04, Vol.14 (1), p.76-76, Article 76
• Main Authors: Czifra, Arpád, Páll, Alida, Kulcsár, Julianna, Barta, Kitti, Kertész, Attila, Paragh, György, Lőrincz, István, Jenei, Zoltán, Agarwal, Anupam, Zarjou, Abolfazl, Balla, József, Szabó, Zoltán
• Format: Article
• Language: English
• Subjects: Aged; Atherosclerosis; Blood pressure; Cardiovascular disease; Colleges & universities; Drug therapy; Evaluation; Female; Free radicals; Heart Ventricles - diagnostic imaging; Heart Ventricles - metabolism; Hemodiafiltration - methods; Hemodialysis; Humans; Kidney diseases; Male; Medical research; Medicine, Experimental; Middle Aged; Molecular weight; Mortality; Nephrology; Nitric oxide; Nitric Oxide - blood; Physiological aspects; Renal Dialysis - methods; Statistical analysis; Ultrasonography; Ventricular Function, Left - physiology
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/1471-2369-14-76

Renal replacement therapy may have a favorable effect on diastolic left ventricular function, but it is not clear whether hemodiafiltration is superior to hemodialysis in this field. Nitric oxide (NO) and asymmetric dimethylarginine (ADMA) may play a role in the changes of intracardiac hemodynamics, but it is not clear whether the different renal replacement methods have disparate influence on the metabolism of these materials. Thirty patients on renal replacement therapy were investigated. First, data was analyzed while patients received hemodiafiltration over a period of three months. Then, the same patients were evaluated during treatment with hemodialysis for at least another three months. Echocardiography was performed before and after renal replacement therapy. No significant difference was found in the volume removals between hemodialysis and hemodiafiltration. The left atrial diameter and transmitral flow velocities (E/A) decreased significantly only during hemodiafiltration. A positive correlation was observed between the left atrial diameter and E/Ea representing the left ventricular pressure load during hemodiafiltration. Significant correlations between NO and A and E/A were observed only in the case of hemodiafiltration. Hemodiafiltration has a beneficial effect on echocardiographic markers representing left ventricular diastolic function. This could be attributed to the differences between the dynamics of volume removal and its distribution among liquid compartments.