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[Evaluation of cardiac function during hemopurification in patients with chronic renal failure]
Insights
Hemofiltration (HF) impacts cardiac function less than hemodialysis (HD). Diabetic patients undergoing HD show impaired cardiac oxygen use and compensatory mechanisms compared to non-diabetics.
Area of Science:
- Nephrology
- Cardiology
- Critical Care Medicine
Background:
- Chronic renal failure necessitates hemopurification techniques like hemodialysis (HD) and hemofiltration (HF).
- Cardiac function can be significantly affected during renal replacement therapy, particularly in diabetic patients.
Purpose of the Study:
- To compare the effects of hemodialysis (HD) and hemofiltration (HF) on cardiac function in patients with chronic renal failure.
- To investigate cardiac function differences during HD between diabetic and non-diabetic patients.
Main Methods:
- A crossover study involving 26 chronic renal failure patients, measuring cardiac function with a Swan-Ganz catheter before and hourly after hemopurification.
- Comparison of cardiac function parameters, including left ventricular stroke work index (SWI) and pulmonary capillary wedge pressure (PCWP), during HD and HF.
- Analysis of cardiac function in 12 diabetic (DN) and 14 non-diabetic (non-DN) patients during HD, assessing SWI, double product, and systemic vascular resistance index (SVRI).
Main Results:
- Hemofiltration (HF) resulted in smaller variations in left ventricular stroke work index (SWI) and pulmonary capillary wedge pressure (PCWP) compared to hemodialysis (HD), indicating less impact on cardiac function.
- Diabetic patients (DN group) showed a tendency for smaller increases in SWI with increased double product during HD compared to non-diabetic patients (non-DN group).
- The regression of systemic vascular resistance index (SVRI) variation to SWI variation was positive in the DN group and negative in the non-DN group during HD, suggesting impaired compensatory mechanisms in diabetics.
Conclusions:
- Hemofiltration (HF) exerts less influence on left ventricular contractility and cardiac function compared to hemodialysis (HD).
- Diabetic patients undergoing hemodialysis exhibit potentially less effective cardiac oxygen utilization and impaired compensatory responses to fluid removal compared to non-diabetic individuals.
Abstract:
Evaluation of cardiac function during hemopurification was performed in 26 patients with chronic renal failure. Cardiac function was measured with a Swan-Ganz thermodilution catheter prior to and every hour after starting the procedure. The effects of hemodialysis (HD) and hemofiltration (HF) on cardiac function were compared by crossover study. The variation in the left ventricular stroke work index (SWI) associated with the reduction in the pulmonary capillary wedge pressure (PCWP) was smaller (p less than 0.05) during HF than during HD. The reduction in PCWP and the variation in SWI associated with the increase in the rate of water elimination were smaller (p less than 0.05) during HF than during HD. These findings suggested that in terms of left ventricular contractility, HF had less effect on cardiac function than did HD. In the second part of the study, 12 diabetic patients (DN group) were compared with 14 non-diabetic (non-DN group) in terms of cardiac function during HD. The rise in the variation in SWI associated with the increase in the variation in the double product tended to be smaller in the DN group than in the non-DN group. The regression coefficient of the variation in the systemic vascular resistance index (SVRI) to the variation in SWI for the DN group was positive, and different (p less than 0.05) from the negative coefficient obtained for the non-DN group. These results suggested that during HD the DN group had less effective utilization of oxygen in cardiac muscle and an impaired compensatory mechanism for decreases in cardiac function associated with increased water elimination than did the non-DN group.