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Updated: Jan 24, 2026
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Changes in left ventricular filling parameters before and after dialysis in patients with end stage renal disease
Mads Ersbøll1,2,3, Anna Axelsson Raja4,5, Peder Emil Warming4,6
1Department of Cardiology, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark. mads.ersboell@gmail.com.
Insights
Diastolic dysfunction (DD) grading in end-stage renal disease (ESRD) patients on hemodialysis (HD) is timing-dependent. Sustained DD post-HD indicates severe cardiac remodeling and a worse patient outlook.
Area of Science:
- Cardiology
- Nephrology
- Echocardiography
Background:
- Cardiovascular disease is a major cause of mortality in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD).
- Left ventricular hypertrophy (LVH) is common in ESRD, but the impact of HD on diastolic dysfunction (DD) grading remains unclear.
- Echocardiographic assessment of cardiac function is crucial for managing ESRD patients.
Purpose of the Study:
- To investigate the impact of hemodialysis (HD) on the grading of diastolic dysfunction (DD) in patients with end-stage renal disease (ESRD).
- To determine if DD assessment timing relative to HD influences classification and patient outcomes.
- To identify characteristics of ESRD patients with sustained DD after HD.
Main Methods:
- Collected comprehensive echocardiographic data from 247 patients before and 239 patients immediately after a standard HD regimen.
- Graded diastolic dysfunction (DD) using current recommendations both pre- and post-HD.
- Analyzed patient demographics, comorbidities (diabetes, hypertension), left ventricular mass index (LVMi), left ventricular ejection fraction (LVEF), and global longitudinal strain (GLS).
Main Results:
- Pre-HD, 34% of patients had DD. Post-HD, 16% exhibited sustained DD.
- Patients with sustained DD were older, more likely to have diabetic or hypertensive ESRD, and showed more advanced myocardial adverse remodeling (higher LVMi, lower LVEF, impaired GLS).
- Echocardiographic evaluation of DD is critically dependent on timing relative to dialysis, with post-HD assessment identifying a high-risk subgroup.
Conclusions:
- The presence and grading of diastolic dysfunction (DD) in end-stage renal disease (ESRD) patients on hemodialysis (HD) are significantly influenced by the timing of echocardiographic assessment relative to the dialysis session.
- Sustained DD identified after volume unloading by HD is associated with an adverse cardiac phenotype, including severe cardiac remodeling and blunted vascular response.
- These findings underscore the importance of considering the dialysis cycle when evaluating cardiac function in ESRD patients.
Abstract:
The aim of this study was to investigate the grading of diastolic dysfunction (DD) in relation to hemodialysis in patients with end stage renal disease (ESRD) on hemodialysis (HD) Cardiovascular disease is prevalent in patients with ESRD and accounts for significant morbidity and mortality. Left ventricular hypertrophy (LVH) is common in ESRD but little is known about the impact of HD on currently recommended grading schemes for DD. Comprehensive echocardiographic data was obtained in consecutive patients with ESRD before (n = 247) and immediately after (n = 239) standard HD regimen. Grading of DD was performed according to current recommendations both pre- and post HD. Prior to HD, DD was classified as present in 83 patients (34%), indeterminate in 51 patients (21%) and absent in 113 patients (45%). Patients with DD at baseline compared to those without were older [67.3 years (13.1) vs. 63.2 (14.3), p = 0.037], were more likely to have diabetic- or hypertensive ESRD (43.4% vs. 35.4%, p = ns) and LVMi was significantly higher [119 g/cm2 (27.5) vs. 103 g/cm2 (24.3), p < 0.001]. After HD [mean HD time = 221 min (27.6), mean ultrafiltration volume = 2 L (1.1)], 39 patients (16%) exhibited sustained DD. These patients were older [69.4 years (14.5) vs. 65.0 years (13.9), p = 0.071], were more likely to have diabetic- or hypertensive ESRD (59% vs. 36%, p = 0.010). Myocardial adverse remodeling was more advanced with higher LVMi [127.4 g/m2 (27.5) vs. 106.5 g/m2 (25.3), p < 0.001], lower LVEF [44.7% (11.0) vs. 54.5% (8.7), p < 0.001] and more impaired GLS [- 13.4% (4.3) vs. - 15.8% (4.0), p = 0.006]. Echocardiographic evaluation of diastolic function in patients with ESRD on HD is critically dependent on timing relative to dialysis. The presence of sustained DD after volume unloading by HD identifies a population of patients with an adverse phenotype of blunted vascular response and severe cardiac remodeling.
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