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Circulatory state of patients on chronic hemodialysis
Insights
Patients on hemodialysis often show signs of heart strain and pulmonary congestion. This study suggests excessive cardiac workload in renal failure can lead to heart issues, potentially managed with vasodilators.
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- Chronic hemodialysis patients often present with cardiovascular complications.
- Elevated cardiothoracic ratio is common, indicating potential cardiac abnormalities.
Purpose of the Study:
- To investigate circulatory abnormalities, specifically pulmonary congestion, in patients undergoing chronic hemodialysis.
- To explore the relationship between cardiac workload, pulmonary artery wedge pressure, and cardiothoracic ratio in this population.
Main Methods:
- Cardiac catheterization was performed on 16 patients undergoing chronic hemodialysis.
- Echocardiography was used to rule out pericardial effusion.
- Laboratory data, body weight, and hemodynamic parameters were analyzed.
Main Results:
- 14 out of 16 patients had a cardiothoracic ratio >50%.
- Elevated cardiac index (4.7 L/min/m2) and left ventricular stroke work index (85 g.m/m2) were observed.
- Pulmonary artery wedge pressure was elevated in 6 patients and correlated with cardiac work (r=0.53) and cardiothoracic ratio (r=0.64).
Conclusions:
- Patients on chronic hemodialysis exhibit circulatory abnormalities, including pulmonary congestion, due to excessive cardiac workload.
- Factors like anemia, fluid retention, and hypertension can exacerbate cardiac strain, potentially leading to pulmonary edema.
- Vasodilator therapy may be beneficial in reducing elevated pulmonary artery wedge pressure and managing cardiac load.
Abstract:
In 16 patients on chronic hemodialysis, the cardiac catheterization was performed. They had received the hemodialytic treatment for 41 months in the average. All but two cases had cardiothoracic ratio above 50%. It was 58 +/- 7% in all. The laboratory data, body weight, or the interdialytic body weight change was comparable with those of other patients with normal heart size. Pericardial effusion was denied by echocardiographic study. Cardiac index and the left ventricular stroke work index were higher than normal; 4.7 L/min/m2, and 85 +/- 31 g.m/m2 respectively. Cardiac index was higher than 3.9 L/min/m2 in 11 patients and left ventricular stroke work index was above 68 g.m/m2 (= mean value of control). The pulmonary artery wedge pressure was 16 +/- 6 mmHg and abnormally high in six patients (greater than 15 mmHg). The pulmonary artery wedge pressure was found to be correlated with the cardiac work (r = 0.53, p less than 0.02), and with the cardiothoracic ratio (r = 0.64, po less than 0.02). The present study revealed a circulatory abnormality of pulmonary congestion which may be brought by an excessive load upon the heart in the renal failure patients A further increase in the cardiac work by aggravation of anemia, retention of body fluid, or the elevation of blood pressure may easily result in an acute pulmonary edema. The reduction of the load by vasodilator may be useful for the relief of the acute rise of the pulmonary artery wedge pressure as suggested in the study of a small group in the present paper.