[Effects of maintenance hemodialysis on right ventricular dysfunction in patients with end-stage renal disease].

OBJECTIVE

To analyze the effects of maintenance hemodialysis (HD) on right ventricular dysfunction (RVD) in the patients with end-stage renal disease (ESRD).

METHODS

The study population consisted of 67 patients with ESRD, who were maintained on long-term hemodialysis therapy via surgically created native arteriovenous (A-V) access in our HD center. The patients were divided into pulmonary hypertension (PHT) and non-PHT groups according to systolic pulmonary artery pressure (sPAP). Doppler echocardiography of right ventricular (RV), left ventricular ejection fraction (LVEF) and vascular access flow were performed in all patients. Echocardiography parameters of RV, dialysis related factors as well as clinical data were collected and compared between the two groups. The risk factors of PHT were analyzed by logistic regression analysis.

RESULTS

There were 25 patients (37.31%) had PHT, while 12 patients (17.91%) had right ventricular hypertrophy. Compared with the non-PHT group, the patients with PHT had a higher systolic blood pressure (P < 0.01), while had a lower level of hemoglobin and Kt/V value (P = 0.03 and P < 0.01 respectively). The patients in PHT group demonstrated lower LVEF than those in non-PHT group (P = 0. 04). The PHT group showed a higher incidence of RV hypertrophy (P = 0.04). Additionally, PHT patients exhibited worse RV diastolic function compared to non-PHT patients. However, there was no statistical difference in vascular access flow between the two groups. Pearson correlation analysis showed that sPAP was correlated with systolic blood pressure and RV wall thickness positively (r = 0.246, 0.394, P < 0.05), while with LVEF negatively (r = -0.373, P = 0.002). The results of logistic regression analysis revealed that LVEF contributed to the predictability of incidence of PHT ( regression coefficient b = -0.096, OR = 1.100, P = 0.01) as well as systolic blood pressure ( regression coefficient b = 0.063, OR = 0.940, P = 0.002).

CONCLUSIONS

The high incidence of PHT and RV hypertrophy in ESRD patients under maintenance hemodialysis via surgically created native arteriovenous access arrange from one fifth to one third. The status of LV function, poor control of systolic blood pressure may play important roles in the mechanism of PHT, RV hypertrophy and RV diastolic dysfunction in chronic uremia patients.