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Occurrence of regional left ventricular dysfunction in patients undergoing standard and biofeedback dialysis
Nicholas M Selby1, Stewart H Lambie, Paolo G Camici
1Department of Renal Medicine, Derby City Hospital, Derby, London, UK. nick.selby@nhs.net
Summary
Hemodialysis causes temporary heart muscle dysfunction in patients. Biofeedback dialysis improves stability and reduces these cardiac events, offering a potential intervention for heart failure in dialysis patients.
Area of Science:
- Cardiology
- Nephrology
- Cardiovascular Medicine
Background:
- Dialysis patients have high rates of cardiac failure and death.
- Subclinical myocardial ischemia contributes to heart failure in the general population.
- This study investigates if hemodialysis induces myocardial ischemia.
Purpose of the Study:
- To determine if hemodialysis (HD) causes left ventricular wall motion abnormalities.
- To compare the effects of standard HD versus biofeedback dialysis on cardiac function.
- To assess if biofeedback dialysis can mitigate dialysis-induced cardiac stress.
Main Methods:
- A randomized crossover study involving 8 patients prone to hypotension during dialysis.
- Serial echocardiography to quantify ejection fraction and regional left ventricular function.
- Continuous pulse wave analysis to monitor blood pressure and hemodynamic variables.
Main Results:
- More regional wall motion abnormalities occurred during standard HD (42) versus biofeedback dialysis (23).
- Left ventricular function was significantly more impaired during HD, with lower ejection fraction.
- Biofeedback dialysis demonstrated improved hemodynamic stability, with fewer hypotensive episodes.
Conclusions:
- Reversible left ventricular wall motion abnormalities develop during hemodialysis with ultrafiltration.
- Biofeedback dialysis ameliorates these abnormalities by improving hemodynamic stability.
- This suggests biofeedback dialysis is a potential intervention to reduce cardiac stress in dialysis patients.
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