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Cardiac function and cardiovascular hormone balance during hemodialysis with special reference to atrial natriuretic
U Andersson1, C Sylvén, K Lindvall
1Karolinska Institute, Department of Internal Medicine, Danderyd Hospital, Sweden.
Insights
Hemodialysis improves cardiac function by reducing left ventricular dimensions and normalizing ejection fraction in patients with chronic kidney disease. This treatment also lowers atrial natriuretic peptide levels, indicating fluid balance restoration.
Area of Science:
- Cardiology
- Nephrology
- Endocrinology
Background:
- Patients on chronic hemodialysis often exhibit left ventricular hypertrophy (LVH) and altered cardiovascular hormone levels.
- Fluid overload and metabolic changes associated with kidney disease contribute to cardiac dysfunction.
Purpose of the Study:
- To assess the impact of hemodialysis on left ventricular function and cardiovascular hormone balance in patients with chronic kidney disease.
- To investigate the relationship between body weight changes, cardiac dimensions, and hormone levels post-hemodialysis.
Main Methods:
- Echocardiography to evaluate left ventricular function and dimensions.
- Measurement of plasma levels of atrial natriuretic peptide (ANP), antidiuretic hormone (ADH), renin activity, and aldosterone before and after hemodialysis.
- Correlation analysis between body weight changes and ANP levels.
Main Results:
- Hemodialysis led to a significant decrease in body weight, left atrial and ventricular dimensions, and normalization of ejection fraction in most patients.
- Plasma levels of ANP significantly decreased post-hemodialysis, with a correlation between body weight reduction and ANP decrease.
- Antidiuretic hormone levels remained elevated, while renin activity and aldosterone were low and unchanged.
Conclusions:
- Hemodialysis effectively improves cardiac function and reduces fluid overload in patients with chronic kidney disease.
- LVH in these patients may result from a combination of volume overload and impaired myocardial function.
- ANP levels serve as a marker for fluid status changes during hemodialysis.
Abstract:
Echocardiographically determined left ventricular function and cardiovascular hormone balance were assessed before and after hemodialysis in 10 patients who had been on hemodialysis for 4 months to 15 years. Plasma levels of atrial natriuretic peptide (ANP), antidiuretic hormone (ADH), renin activity and aldosterone were determined. All patients had vector- and echocardiographic evidences of slight to moderate left ventricular hypertrophy. The body weight decreased 2.0 kg (3.3 +/- 0.5%) with dialysis. Nine out of ten patients showed a slightly reduced ejection fraction that normalized after dialysis (p less than 0.05). Left atrial and ventricular systolic dimensions were around the upper reference limit before dialysis with a decrease after dialysis (p less than 0.05 and p less than 0.02, respectively). The levels of ANP decreased with dialysis from 2-17 times to 1 to 15 times the upper reference value in nine out of the ten patients. In the whole group the decrease was 117 +/- 35% (p less than 0.005). A significant regression was obtained between percentage decrease of body weight and percentage change of ANP (r = 0.67; p less than 0.05). The plasma concentration of ADH did not change following dialysis but the mean value was significantly higher than the mean value of the reference group of the laboratory (p less than 0.05 before and p less than 0.005 after dialysis). Renin activity and aldosterone levels were low and did not change during dialysis. In conclusion, the slight left ventricular hypertrophy may partly be a response to volume overload with hyperdynamic circulation and partly to metabolically depressed myocardial function.(ABSTRACT TRUNCATED AT 250 WORDS)