LEFT VENTRICULAR MORPHOFUNCTIONAL CHANGES AND ASSOCIATED FACTORS IN END-STAGE KIDNEY DISEASE PATIENTS ON MAINTENANCE HEMODIALYSIS WITH HDF ONLINE
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Abstract
Background: End-stage kidney disease (ESKD) frequently induces early left ventricular remodeling and dysfunction, even in patients with preserved left ventricular ejection fraction (LVEF). Objectives: 1. To describe the clinical and paraclinical characteristics, as well as the prevalence of left ventricular morphological and functional abnormalities; 2. To evaluate postinterventional changes in left ventricular morphology and function; 3. To identify factors associated with post-interventional left ventricular hypertrophy in patients with end-stage kidney disease undergoing maintenance hemodialysis combined with online hemodiafiltration (online HDF) Subjects and methods: In this descriptive cross-sectional study with longitudinal follow-up, we enrolled 100 patients undergoing maintenance hemodialysis with online HDF (1-3 sessions/month) at Ninh Thuan General Hospital. Echocardiographic evaluations, including two-dimensional, Doppler, and tissue Doppler imaging (TDI), were performed at baseline and repeated after 6 months. Results: At enrollment, morphological abnormalities were detected in 89% of patients, with concentric LVH predominating (57%). The mean LV mass index (LVMI) was 147.07 ± 49.92 g/m². Although LVEF averaged 61.18 ± 11.69% (81% > 50%), TDI revealed subclinical systolic and diastolic impairment: septal Sm 6.78 ± 2.28 cm/s, lateral Sm 7.75 ± 2.31 cm/s, E/A 0.92 ± 0.41, septal Em 6.51 ± 2.29 cm/s, lateral Em 8.21 ± 3.09 cm/s, E/Em 11.46 ± 4.67, and a Tei index of 0.74 ± 0.20. After 6 months of continued therapy, significant favorable changes were observed, including reduced LV posterior wall thickness (−0.82 ± 2.48 mm) and relative wall thickness (−0.0471 ± 0.1485, both p < 0.05), along with improved E/A ratio, albeit with an increase in IVRT (31.20 ± 40.06 ms). Notably, baseline LVMI and pre-dialysis systolic blood pressure (SBP) emerged as independent predictors of post-intervention LVMI. Conclusion: Maintenance hemodialysis patients with end-stage CKD exhibit an alarmingly high burden of LVH and diastolic dysfunction. Pre-dialysis SBP is an independent predictor of LVH, emphasizing the critical role of stringent blood pressure management in long-term cardiovascular risk reduction.
Keywords
End‑stage chronic kidney disease, maintenance hemodialysis, online hemodiafiltration, left ventricular hypertrophy, left ventricular dysfunction
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