Effects of acetate versus bicarbonate hemodialysis on left ventricular size and function

To investigate the effects of different types of hemodialysis on hemodynamics, left ventricular size and function, 10 patients with uremia due to chronic renal failure were examined using echocardiography and measurement of systolic time intervals before and after both acetate and bicarbonate hemodialysis. Both caused decreases in left ventricular end diastolic (acetate -3.2 vs. bicarbonate -5.1 mm, p less than 0.01 for both) and end systolic (-3.2 vs. -3.7 mm, p less than 0.01 for both) diameters, and increases in mVCF (+0.24 vs. +0.23 circ/s, p less than 0.005 for both) and fractional shortening (+2.7%, p less than 0.05 vs. +0.9%, NS). In systolic time intervals, the LVETI decreased (-28 vs. -38 ms, p less than 0.001 for both) and the PEP/LVET ratio increased (+0.04, NS vs. 0.09, p less than 0.01). There were no significant differences between the changes in any of the measured parameters caused by acetate or bicarbonate hemodialysis, except in blood bicarbonate concentration (+1.9 vs. +5.4 mmol/l, difference p less than 0.01). Thus hemodialysis with acetate or bicarbonate base causes similar decreases in left ventricular size apparently because of decreased diastolic filling, but in spite of this, there is an increase in left ventricular systolic function, apparently partially due to increased myocardial contractility.