Effect of hemodialysis on cardiac morphology and function, pulse wave velocity and carotid intima media thickness in patients with end stage renal disease

The global burden of chronic renal disease (CKD) is rising rapidly worldwide in terms of increasing rates of frequency, mortality and renal replacement therapy (RRT). The most prominent reason of mortality among end-stage renal disease (ESRD) patients is cardiovascular (CV) complications. Conventional CV risk factors are also more frequent in CKD patients compared to normal population. Likewise, risk of developing arterial vascular disease and cardiomyopathy is higher. Present study aims to investigate the influence of hemodialysis on cardiac morphology and function, artery wall thickness and stiffness among ESRD patients. Sixty patients with ESRD are included who are admitted to the Nephrology outpatient clinic of Akdeniz University Hospital between November 2011 - April 2012. Thirty of the patients were having hemodialysis for at least 6 months whereas remaining patients were not having hemodialysis yet. The patients with atrial fibrillation, rheumatic heart disease, severe valvular heart disease, kongenital heart disease, familial mediterranean fever, diabetes mellitus, coronary artery disease (CAD) and peripheral artery disease and who has the history of valvular surgery, cerebrovascular disease, renal transplantaion and peritoneal dialysis and who has insufficient ECHO window and ejection fraction lesser than 50% are excluded from the study. Morphological measurements of left ventricule and doppler parameters are recorded and analysed. Pulse-wave velocity (PWV) and carotis intima-media thickness (CIMT) are also recorded. After completing data collection statistical analysis were done. Concerning demographical data there were no differences between groups regarding age, height and duration of CKD. Average weight and body mass index (BMI) levels were higher in preemptive group (p=0.026 and 0.11). Sex distribution was similar in both groups. The rates of patients with hypertension and hyperlipidemia was higher in preemptive group (p=0.045, p=0.004). Concerning biochemical parameters, creatinine levels were higher in hemodialysis group (p<0.001) and MDRD levels ara higher in preemptive group (p<0.001). Left atrial volume (LAV) which is an echocardiographic parameter was higher in hemodialysis group (p<0.001) whereas deceleration time (DT) was shorter in hemodialysis group (p<0.001). There were no differences between groups in terms of parameters rather than we mentioned above. Left ventricular diastolic disfunction (LVDD) also showed no significant difference between groups. Rates of left ventricule hypertrophy (LVH) were similar in both groups. In terms of PWV and CIMT, no significant difference was observed. Despite the durations of CKD were similar in both groups, rates of MDRD were lower in hemodialysis group. LAV was elevated in hemodialysis group which indicates rapid progression of CKD in hemodialysis group despite similar duration of illness among groups. DT was longer in preemptive group (197,67±27,44 and 238,33±43,68). This finding could be a sign of improved diastolic parameters however remaining echocardiographic parameters did not support it. As a result, even though both groups are consisting of ESRD patients, subjects having hemodialysis were in further stages of disease which prevents evaluating the effect of hemodialysis clearly. Even though hemodialysis is the most frequent treatment modality among ESRD patients, long term efficiency of hemodialysis is unclear and renal transplantation should be considered for each patient