Charalampos Loutradis1, Christodoulos E Papadopoulos2, Vassilios Sachpekidis3, Robert Ekart4, Barbara Krunic5, Antonios Karpetas6, Athanasios Bikos7, Ioannis Tsouchnikas1, Efstathios Mitsopoulos8, Aikaterini Papagianni1, Carmine Zoccali9, Pantelis Sarafidis10. 1. Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. 2. Third Department of Cardiology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. 3. Department of Cardiology, Papageorgiou Hospital, Thessaloniki, Greece. 4. Department of Dialysis, University Clinical Centre Maribor, Clinic for Internal Medicine, Maribor, Slovenia. 5. Department of Cardiology, University Clinical Centre Maribor, Clinic for Internal Medicine, Maribor, Slovenia. 6. Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; Therapeutiki Hemodialysis Unit, Thessaloniki, Greece. 7. Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; Protypo Hemodialysis Unit, Thessaloniki, Greece. 8. Department of Nephrology, Papageorgiou Hospital, Thessaloniki, Greece. 9. CNR-IFC Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy. 10. Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. Electronic address: psarafidis11@yahoo.gr.
Abstract
RATIONALE & OBJECTIVE: Left ventricular (LV) hypertrophy and dysfunction are associated with adverse outcomes in hemodialysis patients. Hypertension and hypervolemia play important roles in these cardiac abnormalities. We report on the prespecified secondary outcome, echocardiographic indexes of LV function, from a previously reported study of the effect of lung ultrasound (US)-guided dry weight reduction on systolic blood pressure. STUDY DESIGN: Single-blind randomized trial. SETTINGS & PARTICIPANTS: 71 clinically euvolemic hypertensive hemodialysis patients in Greece and Slovenia. INTERVENTION: The active intervention group's (n=35) volume removal was guided by the total number of lung US B-lines observed every week before a midweek dialysis session. The usual-care group (n=36) was treated using standard-of-care processes that did not include acquisition of US data. OUTCOMES: 2-dimensional and tissue Doppler echocardiographic indexes at baseline and study end (8 weeks) that evaluated left and right heart chamber sizes, as well as systolic and diastolic function. RESULTS: Overall, 19 (54%) patients in the active intervention and 5 (14%) in the usual-care group had ultrafiltration intensification (P<0.001) during follow-up; changes in US B-lines (-5.3±12.5 vs+2.2±7.6; P<0.001) and dry weight (-0.71±1.39 vs+0.51±0.98kg; P<0.001) significantly differed between the active and usual-care groups. Inferior vena cava diameter decreased in the active compared with the usual-care group (-0.43±4.00 vs 0.71±4.82cm; P=0.03) at study end. Left (LA) and right (RA) atrial dimensions decreased more in the active group (LA surface, -1.09±4.61 vs 0.93±3.06cm2; P=0.03; RA surface -1.56±6.17 vs 0.47±2.31; P=0.02). LA volume index nominally decreased more in the active group (-2.43±13.14 vs 2.95±9.42mL/m2), though this was of borderline statistical significance (P=0.05). Reductions in LV end-diastolic diameter and volume were marginally greater in the active group. The change in LV filling pressures was significantly different in the active compared with the usual-care group (early transmitral diastolic velocities ratio [E/e'], -0.38±3.14 vs 1.36±3.54; P=0.03; E wave deceleration time, 35.43±85.25 vs-18.44±50.69; P=0.002]. Systolic function indexes were unchanged in both groups. In multivariable analysis, US B-line reduction was associated with a reduction in the E/e' LV ratio (OR, 4.542; 95% CI, 1.266-16.292; P=0.02). LIMITATIONS: Exploratory study; small sample size. CONCLUSIONS: A US-guided strategy for dry weight reduction is associated with decreased cardiac chamber dimensions and LV filling pressure, but no difference in systolic performance compared with usual care in hypertensive hemodialysis patients. FUNDING: European Renal Association-European Dialysis and Transplant Association. TRIAL REGISTRATION: Registered at ClinicalTrials.gov with study number NCT03058874.
RCT Entities:
RATIONALE & OBJECTIVE:Left ventricular (LV) hypertrophy and dysfunction are associated with adverse outcomes in hemodialysis patients. Hypertension and hypervolemia play important roles in these cardiac abnormalities. We report on the prespecified secondary outcome, echocardiographic indexes of LV function, from a previously reported study of the effect of lung ultrasound (US)-guided dry weight reduction on systolic blood pressure. STUDY DESIGN: Single-blind randomized trial. SETTINGS & PARTICIPANTS: 71 clinically euvolemic hypertensive hemodialysispatients in Greece and Slovenia. INTERVENTION: The active intervention group's (n=35) volume removal was guided by the total number of lung US B-lines observed every week before a midweek dialysis session. The usual-care group (n=36) was treated using standard-of-care processes that did not include acquisition of US data. OUTCOMES: 2-dimensional and tissue Doppler echocardiographic indexes at baseline and study end (8 weeks) that evaluated left and right heart chamber sizes, as well as systolic and diastolic function. RESULTS: Overall, 19 (54%) patients in the active intervention and 5 (14%) in the usual-care group had ultrafiltration intensification (P<0.001) during follow-up; changes in US B-lines (-5.3±12.5 vs+2.2±7.6; P<0.001) and dry weight (-0.71±1.39 vs+0.51±0.98kg; P<0.001) significantly differed between the active and usual-care groups. Inferior vena cava diameter decreased in the active compared with the usual-care group (-0.43±4.00 vs 0.71±4.82cm; P=0.03) at study end. Left (LA) and right (RA) atrial dimensions decreased more in the active group (LA surface, -1.09±4.61 vs 0.93±3.06cm2; P=0.03; RA surface -1.56±6.17 vs 0.47±2.31; P=0.02). LA volume index nominally decreased more in the active group (-2.43±13.14 vs 2.95±9.42mL/m2), though this was of borderline statistical significance (P=0.05). Reductions in LV end-diastolic diameter and volume were marginally greater in the active group. The change in LV filling pressures was significantly different in the active compared with the usual-care group (early transmitral diastolic velocities ratio [E/e'], -0.38±3.14 vs 1.36±3.54; P=0.03; E wave deceleration time, 35.43±85.25 vs-18.44±50.69; P=0.002]. Systolic function indexes were unchanged in both groups. In multivariable analysis, US B-line reduction was associated with a reduction in the E/e' LV ratio (OR, 4.542; 95% CI, 1.266-16.292; P=0.02). LIMITATIONS: Exploratory study; small sample size. CONCLUSIONS: A US-guided strategy for dry weight reduction is associated with decreased cardiac chamber dimensions and LV filling pressure, but no difference in systolic performance compared with usual care in hypertensive hemodialysispatients. FUNDING: European Renal Association-European Dialysis and Transplant Association. TRIAL REGISTRATION: Registered at ClinicalTrials.gov with study number NCT03058874.
Authors: Bong-Joon Kim; Soo-Jin Kim; Sung-Il Im; Hyun-Su Kim; Jung-Ho Heo; Ho Sik Shin; Ye Na Kim; Yeonsoon Jung; Hark Rim Journal: Int J Heart Fail Date: 2022-04-15
Authors: Bernard Canaud; Jeroen P Kooman; Nicholas M Selby; Maarten Taal; Andreas Maierhofer; Pascal Kopperschmidt; Susan Francis; Allan Collins; Peter Kotanko Journal: World J Nephrol Date: 2022-03-25