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Pediatric Nephrology

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01-05-2020 | Echocardiography | Original Article

Changes of cardiac functions after hemodialysis session in pediatric patients with end-stage renal disease: conventional echocardiography and two-dimensional speckle tracking study

Authors: Shaimaa Rakha, Mona Hafez, Ashraf Bakr, Nashwa Hamdy

Published in: Pediatric Nephrology | Issue 5/2020

Abstract

Background

Although acute effects of hemodialysis (HD) on cardiac functions in end-stage renal disease (ESRD) have been studied frequently in adults, limited data are available in pediatric age. Therefore, this work elucidates the acute impact of HD on cardiac functions using conventional echocardiography and two-dimensional (2D) speckle tracking in ESRD pediatric patients.

Methods

Between June 2018 and April 2019, 40 ESRD pediatric subjects on chronic HD were prospectively recruited. All patients were subjected to history taking and baseline laboratory tests. Anthropometric measures, heart rate, blood pressure, and bioimpedance were assessed before and after HD session. Moreover, conventional echocardiography including M.mode and Doppler parameters for valves, as well as left ventricle (LV) 2D speckle tracking were performed pre- and post-dialysis session.

Results

The included patients mean age was 12.9 ± 2.9 years, and males were 24 (60%). Significant reductions in body weight and blood pressure were noted after sessions. Post-dialysis LV and left atrial diameters, as well as left atrium to aortic diameter ratio, were lower. Nevertheless, conventional echocardiography-derived LV ejection fraction (EF), and fractional shortening were not significantly changed. Doppler-derived E/A ratio of mitral and tricuspid valves were lower post-dialysis. Global longitudinal strain (GLS) for LV was significantly reduced after dialysis (− 20.31 ± 3.58%, − 17.17 ± 3.40% vs, P < 0.0001), and global circumferential strain (GCS) was lower post-dialysis in comparison to pre-dialysis (− 21.37 ± 6.46% vs − 17.74 ± 6.16%, P < 0.0001). The speckle tracking–derived EF was significantly lower post-dialysis (57.58 ± 6.94 vs 53.64 ± 10.72, P = 0.018). All myocardial segments longitudinal and circumferential strains decreased significantly after dialysis.

Conclusions

Post-hemodialysis significant decline in left ventricular EF as well as global and segmental strains can be detected in ESRD pediatric patients using 2D speckle tracking, despite the nonsignificant changes in systolic functions derived from conventional echocardiography. This is considered additional evidence of HD deleterious effect on myocardial functions, particularly in the pediatric age.

Saran R, Robinson B, Abbott KC, LYC A, Bragg-Gresham J, Balkrishnan R, Bhave N, Dietrich X, Ding Z, Eggers PW, Gaipov A, Gillen D, Gipson D, Gu H, Guro P, Haggerty D, Han Y, He K, Herman W, Heung M, Hirth RA, Hsiung JT, Hutton D, Inoue A, Jacobsen SJ, Jin Y, Kalantar-Zadeh K, Kapke A, Kleine CE, Kovesdy CP, Krueter W, Kurtz V, Li Y, Liu S, Marroquin MV, McCullough K, Molnar MZ, Modi Z, Montez-Rath M, Moradi H, Morgenstern H, Mukhopadhyay P, Nallamothu B, Nguyen DV, Norris KC, O’Hare AM, Obi Y, Park C, Pearson J, Pisoni R, Potukuchi PK, Repeck K, Rhee CM, Schaubel DE, Schrager J, Selewski DT, Shamraj R, Shaw SF, Shi JM, Shieu M, Sim JJ, Soohoo M, Steffick D, Streja E, Sumida K, Kurella Tamura M, Tilea A, Turf M, Wang D, Weng W, Woodside KJ, Wyncott A, Xiang J, Xin X, Yin M, You AS, Zhang X, Zhou H, Shahinian V (2019) US Renal Data System 2018 Annual Data Report: Epidemiology of kidney disease in the United States. Am J Kidney Dis 73(3S1):A7–A8

Chavers BM, Molony JT, Solid CA, Rheault MN, Collins AJ (2015) One-year mortality rates in US children with end-stage renal disease. Am J Nephrol 41:121–128CrossRef

Drighil A, Madias JE, Mathewson JW, El Mosalami H, El Badaoui N, Ramdani B, Bennis A (2008) Haemodialysis: effects of acute decrease in preload on tissue Doppler imaging indices of systolic and diastolic function of the left and right ventricles. Eur J Echocardiogr 9:530–535CrossRef

McIntyre CW, Burton JO, Selby NM, Leccisotti L, Korsheed S, Baker CS, Camici PG (2008) Hemodialysis-induced cardiac dysfunction is associated with an acute reduction in global and segmental myocardial blood flow. Clin J Am Soc Nephrol 3:19–26CrossRef

Wayand D, Baum H, Schätzle G, Schärf J, Neumeier D (2000) Cardiac troponin T and I in end-stage renal failure. Clin Chem 46:1345–1350CrossRef

Conlon P, Krucoff M, Minda S, Schumm D, Schwab S (1998) Incidence and long-term significance of transient ST segment deviation in hemodialysis patients. Clin Nephrol 49:236–239PubMed

Selby NM, Burton JO, Chesterton LJ, McIntyre CW (2006) Dialysis induced regional left ventricular dysfunction is ameliorated by cooling the dialysate. Clin J Am Soc Nephrol 1:1216–1225CrossRef

Hothi DK, Rees L, Marek J, Burton J, McIntyre CW (2009) Pediatric myocardial stunning underscores the cardiac toxicity of conventional hemodialysis treatments. Clin J Am Soc Nephrol 4:790–797CrossRef

Ouali S, Abroug S, Neffeti E, Taamalah S, Hammas S, Ben Khalfallah A, Remedi F, Boughzela E, Harabi A (2010) Effects of acute decrease in preload on echocardiographic indices of systolic and diastolic function of the left ventricle in children with end-stage renal disease (ESRD). Comparative study before and after hemodialysis. Ann Cardiol Angeiol (Paris) 59(1):14–19CrossRef

10.

Abid L, Rekik H, Jarraya F, Kharrat I, Hachicha J, Kammoun S (2014) Acute hemodialysis effects on doppler echocardiographic indices. Saudi J Kidney Dis Transpl 25(4):756–761CrossRef

11.

Hayashi SY, Brodin LA, Alvestrand A, Lind B, Stenvinkel P, do Mazza NM, Qureshi AR, Saha S, Lindholm B, Seeberger A (2004) Improvement of cardiac function after hemodialysis quantitative evaluation by colour tissue velocity. Nephrol Dial Transplant 19:1497–1506CrossRef

12.

Sarafidis PA, Kamperidis V, Loutradis C, Tsilonis K, Mpoutsiouki F, Saratzis A, Giannakoulas G, Sianos G, Karvounis H (2017) Haemodialysis acutely deteriorates left and right diastolic function and myocardial performance: an effect related to high ultrafiltration volumes? Nephrol Dial Transplant 32(8):1402–1409PubMed

13.

Voigt JU, Pedrizzetti G, Lysyansky P, Marwick TH, Houle H, Baumann R, Pedri S, Ito Y, Abe Y, Metz S, Song JH, Hamilton J, Sengupta PP, Kolias TJ, d'Hooge J, Aurigemma GP, Thomas JD, Badano LP (2015) Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. J Am Soc Echocardiogr 28:183–193CrossRef

14.

Mendes L, Ribeiras R, Adragão T, Lima S, Horta E, Reis C, Amaral T, Aguiar C, Gouveia R, Silva A (2008) Load-independent parameters of diastolic and systolic function by speckle tracking and tissue doppler in hemodialysis patients. Rev Port Cardiol 27:1011–1025PubMed

15.

Murata T, Dohi K, Onishi K, Sugiura E, Fujimoto N, Ichikawa K, Ishikawa E, Nakamura M, Nomura S, Takeuchi H, Nobori T, Ito M (2011) Role of haemodialytic therapy on left ventricular mechanical dyssynchrony in patients with end-stage renal disease quantified by speckle-tracking strain imaging. Nephrol Dial Transplant 26:1655–1661CrossRef

16.

Ünlü S, Şahinarslan A, Sezenöz B, Uludağ OM, Gökalp G, Seçkin Ö, Arınsoy ST, Gülbahar Ö, Boyacı NB (2018) High-sensitive troponin T increase after hemodialysis is associated with left ventricular global longitudinal strain and ultrafiltration rate. Cardiol J. https://doi.org/10.5603/CJ.a2018.0118

17.

Ibrahim SS, Koura MA, Emara AA, Kamel M, El-Wahed WA (2016) The effect of hemodialysis-induced preload changes on the left ventricular function: a speckle-tracking echocardiographic study. Menoufia Med J 29:406–411CrossRef

18.

Choi JO, Shin DH, Cho SW, Song YB, Kim JH, Kim YG, Lee SC, Park SW (2008) Effect of preload on left ventricular longitudinal strain by 2D speckle tracking. Echocardiography 25:873–879CrossRef

19.

Amoozgar H, Naghshzan A, Basiratnia M, Ahmadipoor M (2018) Effect of hemodialysis on global and regional cardiac function in children with end-stage renal disease. Iran J Kidney Dis 12:48–52PubMed

20.

Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, Hogg RJ, Perrone RD, Lau J, Eknoyan G, National Kidney Foundation (2003) National Kidney Foundation practice guidelines for chronic kidney disease, evaluation classification and stratification. Ann Intern Med 2003:139–137

21.

Wheeler DC, Becker GJ (2013) Summary of KDIGO guideline. What do we really know about management of blood pressure in patients with chronic kidney disease? Kidney Int 83:377–383CrossRef

22.

Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28:1–39CrossRef

23.

Cheriex EC, Leunissen KM, Janssen JH, Mooy JM, van Hooff JP (1989) Echocardiography of the inferior vena cava is a simple and reliable tool for estimation of ‘dry weight’ in haemodialysis patients. Nephrol Dial Transplant 4:563–568PubMed

24.

de Jager DJ, Grootendorst DC, Jager KJ, van Dijk PC, Tomas LM, Ansell D, Collart F, Finne P, Heaf JG, De Meester J, Wetzels JF, Rosendaal FR, Dekker FW (2009) Cardiovascular and noncardiovascular mortality among patients starting dialysis. JAMA 302:1782–1789CrossRef

25.

Karayaylali I, San M, Kudaiberdieva G, Niyazova-Karben Z, Seyrek N, Balal M, Paydas S, Sagliker Y (2003) Heart rate variability, left ventricular func-tions, and cardiac autonomic neuropathy inpatients undergoing chronic hemodialysis. Ren Fail 25:845–853CrossRef

26.

Zuidema MY, Dellsperger KC (2012) Myocardial stunning with hemodialysis: clinical challenges of the cardiorenal patient. Cardiorenal Med 2:125–133CrossRef

27.

Dincer I, Kumbasar D, Nergisoglu G, Atmaca Y, Kutlay S, Akyurek O, Sayin T, Erol C, Oral D (2002) Assessment of left ventricular diastolic function with Doppler tissue imaging: effects of preload and place of measurements. Int J Cardiovasc Imaging 18:155–160CrossRef

28.

Stoddard MF, Pearson AC, Kern MJ, Ratcliff J, Mrosek DG, Labovitz AJ (1989) Influence of alteration in preload on the pattern of left ventricular diastolic filling as assessed by Doppler echocardiography in humans. Circulation 79:1226–1236CrossRef

29.

Sadler DB, Brown J, Nurse H, Roberts J (1992) Impact of hemodialysis on left and right ventricular Doppler diastolic filling indices. Am J Med Sci 304:83–90CrossRef

30.

Selby NM, McIntyre CW (2013) The vicious cycle of dialysis-induced cardiac injury are dynamic changes in diastolic function involved? Am J Kidney Dis 62:442–444CrossRef

31.

32.

Farsalinos KE, Daraban AM, Ünlü S, Thomas JD, Badano LP, Voigt JU (2015) Head-to-head comparison of global longitudinal strain measurements among nine different vendors: the EACVI/ASE inter-vendor comparison study. J Am Soc Echocardiogr 28:1171–1181CrossRef

33.

Lagies R, Beck BB, Hoppe B, Sheta SS, Weiß V, Sreeram N, Udink ten Cate FE (2015) Inhomogeneous longitudinal cardiac rotation and impaired left ventricular longitudinal strain in children and young adults with end-stage renal failure undergoing hemodialysis. Echocardiography 32:1250–1260CrossRef

34.

Burton JO, Jefferies HJ, Selby NM, McIntyre CW (2009) Hemodialysis-induced repetitive myocardial injury results in global and segmental reduction in systolic cardiac function. Clin J Am Soc Nephrol 4:1925–1931CrossRef

35.

Burton JO, Jefferies HJ, Selby NM, McIntyre CW (2009) Hemodialysis-induced cardiac injury: determinants and associated outcomes. Clin J Am Soc Nephrol 4:914–920CrossRef

36.

Assa S, Hummel YM, Voors AA, Kuipers J, Westerhuis R, de Jong PE, Franssen CF (2012) Hemodialysis-induced regional left ventricular systolic dysfunction: prevalence, patient and dialysis treatment-related factors, and prognostic significance. Clin J Am Soc Nephrol 7:1615–1623CrossRef

Title: Changes of cardiac functions after hemodialysis session in pediatric patients with end-stage renal disease: conventional echocardiography and two-dimensional speckle tracking study
Authors: Shaimaa Rakha
Mona Hafez
Ashraf Bakr
Nashwa Hamdy
Publication date: 01-05-2020
Publisher: Springer Berlin Heidelberg
Keywords: Echocardiography
Echocardiography
Published in: Pediatric Nephrology / Issue 5/2020
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-019-04460-y

At a glance: The ONWARDS insulin icodec trials

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Changes of cardiac functions after hemodialysis session in pediatric patients with end-stage renal disease: conventional echocardiography and two-dimensional speckle tracking study

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

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Abstract

Background

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