Cardiovascular changes in chronic hemodialysis patients

Coronary angiography and left ventricular (LV) hemodynamic studies were performed after dialysis in 32 home dialysis patients (20 men) aged 49.8 +/- 8.0 years. They had been on hemodialysis for 1 to 47 months and were being considered for renal transplantation. The controls were 11 normotensive patients (6 men) aged 46.1 +/- 11 years without coronary artery disease (CAD). Ten (31%) patients had significant CAD (5 single vessel, 3 double vessel, 2 triple vessel). Cardiac index (4.57 +/- 1.3 l/min/m2), LV mass (140 +/- 43 g/m2), mean aortic pressure (103 +/- 20 mm Hg), and LV stroke work index (72 +/- 30 g X m/m2) were significantly elevated while stroke index, heart rate, LV ejection fraction, maximum dP/dT, LV end-diastolic volume and LV end-diastolic pressure were normal. The hemodynamic changes did not correlate with the time on maintenance dialysis nor with the duration of treatment for hypertension. Patients with CAD had higher LV mass and mean aortic pressure than those without CAD. The cardiac changes are thought to result from a combination of pressure and volume loads and anemia.