Hemodynamic effects of hemodialysis: the interaction between the heart and the arteries

Aidana Mustafa1, Aigerim Yermekbay1, Aizhan Zhankorazova1

  • 1Department of Medicine, Nazarbayev University School of Medicine, 5/1 Kerey and Zhanibek Khans Str., 010000, Astana, Kazakhstan.

Journal of Nephrology
|October 7, 2025
PubMed

Insights

Hemodialysis impairs cardiac function by altering left ventricular structure and function, increasing mortality risk. Assessing ventriculo-arterial coupling offers a prognostic marker for kidney failure patients undergoing dialysis.

Area of Science:

  • Cardiovascular Medicine
  • Nephrology
  • Biomedical Engineering

Background:

  • Hemodialysis significantly impacts cardiac function, particularly left ventricular hypertrophy, driven by pressure/volume overload from arteriovenous fistulas, anemia, and fluid retention.
  • Dialysis can impair left ventricular systolic and diastolic functions, reducing ejection fraction and global longitudinal strain, both linked to higher mortality.
  • Chronic dialysis alters arterial structure and function, increasing intima-media thickness and reducing distensibility, leading to elevated afterload.

Purpose of the Study:

  • To investigate the effects of hemodialysis on cardiac morphology and function, including ventriculo-arterial coupling.
  • To highlight the prognostic value of ventriculo-arterial coupling in kidney failure patients.
  • To emphasize the need for comprehensive cardiovascular assessment in dialysis patients.

Main Methods:

  • Utilizing non-invasive tools such as echocardiography and speckle-tracking techniques.
  • Evaluating left ventricular morphology, systolic and diastolic functions, and arterial structure and function.
  • Assessing ventriculo-arterial coupling as a load-independent prognostic marker.

Main Results:

  • Hemodialysis leads to left ventricular hypertrophy and impaired systolic/diastolic function, with transient reductions in ejection fraction and global longitudinal strain.
  • Arterial changes, including increased intima-media thickness and reduced distensibility, contribute to increased afterload.
  • Ventriculo-arterial coupling is identified as a valuable prognostic marker in kidney failure patients.

Conclusions:

  • Comprehensive assessment of ventricular and arterial functions, particularly ventriculo-arterial coupling, is crucial for managing cardiovascular risks in hemodialysis patients.
  • Early detection and intervention strategies targeting fluid management, left ventricular function, and arterial stiffness are essential for improving cardiovascular outcomes.
  • Ventriculo-arterial coupling serves as a key indicator for risk prediction and stratification in this high-risk population.

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