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| The Improvement of LV diastolic function after Hemodialysis in End-Stage Renal Disease Patients is Related to the Amelioration of Endothelial Function |
| Division of Cardiology¹, Division of Nephrology², Department of internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Korea |
| Sung-Ji Park¹, Jeong-Rang Park , Su-nyoung Choi , Tae-Jung Kwon , So-La Park, Young-Ran Kang , Se-Ho Jang² ,Chung-Whan Gak¹ , Jin-Young Hwang¹ |
Background Left ventricular diastolic dysfunction is commonly found, and hemodynamic loading and accumulation of uraemic toxins may influence the myocardial function in hemodialysis(HD) patients. Endothelial dysfunction is common in end-stage renal disease and may contribute to the development of hypertension and atherosclerosis. This study was designed to evaluate cardiac function and endothelial function during a single session of HD, Doppler Tissue Imaging and flow-mediated dilatation of the brachial artery as marker of endothelial function immediately before and after HD Methods Forty chronic hemodialysis patients (22 men; age 59±9 years; time on dialysis 33±4 months) were included. Both mitral inflow velocities and mitral annulus tissue Doppler velocities (Sm, Em, Am) were measured. Plasma concentrations of BNP were measured at pre-and post-dialysis. To estimate the endothelial function, Flow-mediated dilatation (FMD) and nitroglycerin-induced, endothelium-independent vasodilatation (NMD) were measured in brachial artery by using vascular ultrasound. Results Clinical parameters as systolic BP, diastolic BP, and HR were not changed, but body weight decreased. Mitral inflow E and A wave velocities and E/A ratio decreased significantly (P<0.001) after HD.Mitral annulus Sm and Em wave velocities and Em/Am ratios also changed significantly (P<0.05). However, there was no change in the Am wave velocity after hemodialysis.FMD was enhanced after hemodialysis (4.5±2.0% to 9.0±4.0%: P< 0.001), where as NMD was not changed significantly (1.1±5.8% to 1.4±4.9%: P=NS). Plasma level of BNP level (1028±816pg/ml to 884±725pg/ml: P<0.05) was decreased significantly after hemodialysis. Conclusions LV diastolic function, estimated by DTI and BNP,was improved after HD in correlation with improvement of endothelial-dependent vasodilatation, measured by brachial artery FMD in patients on maintenance dialysis therapy. This data suggest that one single session of HD improved diastolic LV function, at least partly, affected by improvement of endothelial dysfunction. Further studies are needed to clarify if this effect of HD is due to the acute removal of fluid, the removal of solutes or both.
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