Document Detail


Hemodialysis-induced cardiac injury: determinants and associated outcomes.
MedLine Citation:
PMID:  19357245     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND OBJECTIVES: Hemodialysis (HD)-induced myocardial stunning driven by ischemia is a recognized complication of HD, which can be ameliorated by HD techniques that improve hemodynamics. In nondialysis patients, repeated ischemia leads to chronic reduction in left ventricular (LV) function. HD may initiate and drive the same process. In this study, we examined the prevalence and associations of HD-induced repetitive myocardial injury and long-term effects on LV function and patient outcomes.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Seventy prevalent HD patients were assessed for evidence of subclinical myocardial injury at baseline using serial echocardiography and followed up after 12 mo. Intradialytic blood pressure, hematologic and biochemical samples, and patient demographics were also collected at both time points.
RESULTS: Sixty-four percent of patients had significant myocardial stunning during HD. Age, ultrafiltration volumes, intradialytic hypotension, and cardiac troponin-T (cTnT) levels were independent determinants associated with its presence. Myocardial stunning was associated with increased relative mortality at 12 mo (P = 0.019). Cox regression analysis showed increased hazard of death in patients with myocardial stunning and elevated cTnT than in patients with elevated cTnT alone (P < 0.02). Patients with myocardial stunning who survived 12 mo had significantly lower LV ejection fractions at rest and on HD (P < 0.001).
CONCLUSIONS: HD-induced myocardial stunning is common, and may contribute to the development of heart failure and increased mortality in HD patients. Enhanced understanding of dialysis-induced cardiac injury may provide novel therapeutic targets to reduce currently excessive rates of cardiovascular morbidity and mortality.
Authors:
James O Burton; Helen J Jefferies; Nicholas M Selby; Christopher W McIntyre
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-04-08
Journal Detail:
Title:  Clinical journal of the American Society of Nephrology : CJASN     Volume:  4     ISSN:  1555-905X     ISO Abbreviation:  Clin J Am Soc Nephrol     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-05-05     Completed Date:  2009-08-13     Revised Date:  2013-06-02    
Medline Journal Info:
Nlm Unique ID:  101271570     Medline TA:  Clin J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  914-20     Citation Subset:  IM    
Affiliation:
Department of Renal Medicine, Derby City Hospital, Derby, UK.
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MeSH Terms
Descriptor/Qualifier:
Aged
Blood Pressure
Female
Follow-Up Studies
Heart Failure / etiology,  mortality
Humans
Kidney Failure, Chronic / mortality*,  therapy*
Male
Middle Aged
Morbidity
Multivariate Analysis
Myocardial Stunning / etiology*,  mortality*
Prevalence
Renal Dialysis / adverse effects*,  mortality*
Risk Factors
Survival Analysis
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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