Routine hemodialysis is associated with an increase in left ventricular contractility that is independent of a change in preload, but the mechanisms responsible are unknown. We investigated the importance of three distinct effects that regularly occur in hemodialysis and could potentially improve left ventricular contractility: the removal of uremic toxins, the increase in the plasma ionized calcium concentration, and the increase in the plasma bicarbonate concentration. Three different dialysates were used for each of eight stable patients on long-term hemodialysis, and left ventricular contractility was assessed by two-dimensional echocardiography before and after each dialysis. In the first procedure neither the ionized calcium nor the bicarbonate concentration was allowed to increase, and left ventricular contractility did not improve. In the second procedure, ionized calcium increased (from 4.4 to 5.4 mg per deciliter, P less than 0.001), bicarbonate concentration was held constant, and contractility increased (from 0.74 to 0.93 circumferences per second, P less than 0.005). In the third procedure, ionized calcium was kept constant, the bicarbonate concentration increased (from 19 to 24 mmol per liter, P less than 0.001), but contractility did not increase. These results suggest that the increase in ionized calcium that occurs in regular dialysis is a key factor in the improvement in left ventricular contractility observed during the procedure.
This article has been cited by other articles:
LeBeouf, A., Mac-Way, F., Utescu, M. S., Chbinou, N., Douville, P., Desmeules, S., Agharazii, M.
(2009). Effects of acute variation of dialysate calcium concentrations on arterial stiffness and aortic pressure waveform. Nephrol Dial Transplant
24: 3788-3794
[Abstract][Full Text]
Drueke, T. B., Touam, M.
(2009). Calcium balance in haemodialysis--do not lower the dialysate calcium concentration too much (con part). Nephrol Dial Transplant
24: 2990-2993
[Abstract][Full Text]
Covic, A., Kothawala, P., Bernal, M., Robbins, S., Chalian, A., Goldsmith, D.
(2009). Systematic review of the evidence underlying the association between mineral metabolism disturbances and risk of all-cause mortality, cardiovascular mortality and cardiovascular events in chronic kidney disease. Nephrol Dial Transplant
24: 1506-1523
[Abstract][Full Text]
Gabutti, L., Bianchi, G., Soldini, D., Marone, C., Burnier, M.
(2009). Haemodynamic consequences of changing bicarbonate and calcium concentrations in haemodialysis fluids. Nephrol Dial Transplant
24: 973-981
[Abstract][Full Text]
Drighil, A., Madias, J. E., Mathewson, J. W., 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: 530-535
[Abstract][Full Text]
Genovesi, S., Dossi, C., Vigano, M. R., Galbiati, E., Prolo, F., Stella, A., Stramba-Badiale, M.
(2008). Electrolyte concentration during haemodialysis and QT interval prolongation in uraemic patients. Europace
10: 771-777
[Abstract][Full Text]
Locatelli, F., Covic, A., Chazot, C., Leunissen, K., Luno, J., Yaqoob, M.
(2004). Optimal composition of the dialysate, with emphasis on its influence on blood pressure. Nephrol Dial Transplant
19: 785-796
[Abstract][Full Text]
Gabutti, L., Ferrari, N., Giudici, G., Mombelli, G., Marone, C.
(2003). Unexpected haemodynamic instability associated with standard bicarbonate haemodialysis. Nephrol Dial Transplant
18: 2369-2376
[Abstract][Full Text]
Durmaz, I., Yagdi, T., Calkavur, T., Mahmudov, R., Apaydin, A. Z., Posacioglu, H., Atay, Y., Engin, C.
(2003). Prophylactic dialysis in patients with renal dysfunction undergoing on-pump coronary artery bypass surgery. Ann. Thorac. Surg.
75: 859-864
[Abstract][Full Text]
VAN DER SANDE, F. M., LUIK, A. J., KOOMAN, J. P., VERSTAPPEN, V., LEUNISSEN, K. M. L.
(2000). Effect of Intravenous Fluids on Blood Pressure Course during Hemodialysis in Hypotensive-Prone Patients. J. Am. Soc. Nephrol.
11: 550-555
[Abstract][Full Text]
Urban, P., Scheidegger, D., Buchmann, B., Barth, D.
(1988). Cardiac Arrest and Blood Ionized Calcium Levels. ANN INTERN MED
109: 110-113
[Abstract]
LANG, R. M., FELLNER, S. K., NEUMANN, A., BUSHINSKY, D. A., BOROW, K. M.
(1988). Left Ventricular Contractility Varies Directly with Blood Ionized Calcium. ANN INTERN MED
108: 524-529
[Abstract]
Aderka, D., Schwartz, D., Dan, M., Levo, Y.
(1987). Bacteremic Hypocalcemia: A Comparison Between the Calcium Levels of Bacteremic and Nonbacteremic Patients With Infection. Arch Intern Med
147: 232-236
[Abstract]
Zaloga, G. P., Chernow, B.
(1986). Hypocalcemia in Critical Illness. JAMA
256: 1924-1929
[Abstract]
MAYNARD, J. C., CRUZ, C., KLEEREKOPER, M., LEVIN, N. W.
(1986). Blood Pressure Response to Changes in Serum Ionized Calcium During Hemodialysis. ANN INTERN MED
104: 358-361
[Abstract]
Previous
