Correlation between asymptomatic intradialytic hypotension and regional left ventricular dysfunction in hemodialysis patients.

INTRODUCTION Cardiovascular disease and heart failure are common in dialysis patients. Recurrent subclinical myocardial ischemia is an important event which may lead to the heart failure. We examined whether this phenomenon occurs secondary to the intradialytic hypotension in hemodialysis patients. MATERIALS AND METHODS Twelve patients prone to intradialytic hypotension who had been on maintenance hemodialysis for more than 12 months and 15 hemodialysis patients without any history of intradialytic hypotension were included in this study. Echocardiography was performed before hemodialysis (baseline), and at 60 minutes and 120 minutes during hemodialysis (climax), and 30 minutes postdialysis (recovery). Left ventricular end-diastolic diameter, left ventricular systolic diameter, left ventricular ejection fraction, fractional shortening of left ventricular, and regional wall motion abnormality score and index were measured during the four stages in all patients. RESULTS Regional wall motion abnormality preceded reduction in the left ventricular ejection fraction and fractional shortening in patients with intradialytic hypotension. However, decreased systolic blood pressure and increased regional wall motion abnormality were accompanied. CONCLUSIONS This study showed that reversible myocardial dysfunction occurs during the hemodialysis. It may be contributed to the intradialytic hypotension. In addition, we showed that regional wall motion abnormality less frequently occurred in patients without intradialytic hypotension. This suggests that confronting with intradialytic hypotension may prevent cardiovascular dysfunction.