Evaluation of left ventricular functions in chronic renal failure before and after acute hemodialysis

Left ventricular functions were evaluated in 25 adult patients of chronic renal failure by 2-D echocardiography before and after four hours of standard hemodialysis session. Eighteen patients showed clinical evidence of fluid overload. Predialysis left ventricular end-diastolic diameter, left ventricular end-diastolic volume, left ventricular end-systolic diameter and left ventricular end-systolic volume were comparable in patients with or without fluid overload. Similarly, predialysis stroke volume and left ventricular ejection fraction were not significantly different in the two subsets. However, following hemodialysis there was a significant decrease in the left ventricular systolic and diastolic volumes and diameters in patients with fluid overload. The improvement in the left ventricular ejection fraction was of the same magnitude in the two subsets. The significant improvement in the left ventricular functions both in patients with and without fluid overload indicates that fluid overload may not be the only determinant of left ventricular functions in patients of chronic renal failure, but other factors, such as various uraemia toxins and metabolic changes might also be inhibiting the myocardial functions.