Zulkarnaev Alexey, Parshina Ekaterina, Dmitriev Ilya, Stepanov Vadim, Fominykh Natalia
Surgery Department of Kidney Transplantation, Moscow Regional Research and Clinical Institute ("MONIKI"), build. 61/2 Shchepkina str, Moscow, 129110, Russia.
Nephrology and Dialysis Department, Saint Petersburg State University Hospital, 154 Fontanka emb, Saint-Petersburg, 198103, Russia.
BMC Nephrol. 2025 Sep 1;26(1):506. doi: 10.1186/s12882-025-04431-6.
Cardiopulmonary recirculation (CPR) is a known risk factor for heart failure (HF). Typically, the assessment is performed on the interdialytic day. Hemodialysis (HD) sessions can induce significant hemodynamic changes, which may be important for patients with HF and preserved ejection fraction (EF), in whom the risk may be underestimated.
To evaluate the dynamics of CPR due to a HD session following a long interdialytic gap in patients with HF and preserved EF.
The prospective cohort single-arm study included 20 adult HD patients who met the inclusion criteria: EF ≥ 50%, NYHA I-II, AVF volume blood flow (Qa) ≥ 1 L/min, CPR < 30%, interdialytic weight gain < 5%, and eKt/V > 1.2. All patients underwent transthoracic echocardiography on the third day after the previous HD session (Monday/Tuesday), 1 h prior to and 2 h after the session. In addition, the Qa of the brachial artery was measured. ClinicalTrials Id: NCT06394986 (May 01, 2024).
A reduction in cardiac preload after HD was evidenced by a decrease in the volume of cardiac chambers, as well as a reduction in pulmonary artery systolic pressure and arterial blood pressure. The EF and Qa slightly decreased (2.46% [95% CI 1.47; 3.45], < 0.001 and 0.12 L/min [95% CI 0.09; 0.14], < 0.001, respectively), whereas cardiac output decreased significantly (1.71 L/min [95% CI 0.8; 2.6], < 0.001). This led to an increase in CPR of 5.1% [95% CI 3.9; 6.4], < 0.001. As a result, in 5 patients, the CPR exceeded 30% after HD. In the sensitivity analysis, no parameters significantly associated with the variance CPR were identified.
Some patients experience a significant increase in CPR after HD. However, the prognostic value of this phenomenon remains unclear. For patients with HF and normal or subnormal CPR measured on the interdialytic day, it is advisable to determine the CPR shortly after HD. This may serve as a ‘stress test’ to identify hidden hemodynamic disorders and manifest the cardiotoxic effect of AVF.
心肺再循环（CPR）是心力衰竭（HF）的已知危险因素。通常，评估在透析间期进行。血液透析（HD）治疗可引起显著的血流动力学变化，这对于射血分数（EF）保留的HF患者可能很重要，因为这类患者的风险可能被低估。
评估在透析间期较长的情况下，HD治疗后HF且EF保留的患者CPR的动态变化。
前瞻性队列单臂研究纳入了20名符合纳入标准的成年HD患者：EF≥50%，纽约心脏协会（NYHA）心功能I-II级，动静脉内瘘（AVF）血流量（Qa）≥1L/min，CPR<30%，透析间期体重增加<5%，且尿素清除指数（eKt/V）>1.2。所有患者在前一次HD治疗后第三天（周一/周二）、治疗前1小时和治疗后2小时接受经胸超声心动图检查。此外，测量肱动脉的Qa。临床试验编号：NCT06394986（2024年5月1日）。
HD治疗后心脏前负荷降低表现为心腔容积减小，以及肺动脉收缩压和动脉血压降低。EF和Qa略有下降（分别为2.46%[95%置信区间1.47；3.45]，P<0.001和0.12L/min[95%置信区间0.09；0.14]，P<0.001），而心输出量显著下降（1.71L/min[95%置信区间0.8；2.6]，P<0.001）。这导致CPR增加5.1%[95%置信区间3.9；6.4]，P<0.001。结果，5例患者HD治疗后CPR超过30%。在敏感性分析中，未发现与CPR变化显著相关的参数。
一些患者HD治疗后CPR显著增加。然而，这一现象的预后价值仍不清楚。对于透析间期测量CPR正常或低于正常的HF患者，建议在HD治疗后不久测定CPR。这可作为一种“压力测试”，以识别潜在的血流动力学紊乱，并显示AVF的心脏毒性作用。
