Study of cardic valvular calcification in ESRD patients on regular hemodialysis [a single center study]

Cardiac valve calcification are common among patients with chronic kidney disease [CKD]. Risk factors include alterations in calcium and phosphorus metabolism, elevated calcium phosphorus product and persistent elevations in plasma parathyroid hormone [PTH]. Echocardiography is a simple and inexpensive method for detection of valvular calcifications as suggested by KDIGO guidelines. 60 Patients on regular HD constituted group A [36 males and 24 females] and 25 healthy volunteers constituted group B. Group A was subdivided into: Group I: 21 patients with no valvular calcification, group 2: 26 patients with aortic valve calcification and group 3: 13 patients with aortic and mitral valve calcification. For all, the following was done: clinical examination, serum Ca, serum P, serum albumin, serum creatinine, BUN and PTH level in blood. M-mode echo cardiography was done for all. Age, duration of dialysis and duration of 1ry kidney disease was higher in group 2 and 3 compared to group 1 [p = 0.0001]. Calcium was higher in group 2 than group 1 [p = 0.09] and group 3 [p = 0.004] than group I phosphorus was higher in group 2 and 3 than group 1 [P = 0.001]. P was higher in group 3 than group 2 [p = 0.0001]. Ca x P was higher in group 2 and 3 than group 1 [p = 0.0001], in group 3 than group 2 [p = 0.01] PTH was higher in group 1 than group 2 [p = 0.06]. Cardiac dysfunction by echocardiography was least in group 1, increasing in group 2 and being highest in group 3. It was found that calcified valve groups has taken higher doses of Calcium and Vitamin D3. We have to take care on prescribing Ca and vitamin D3 to ESRD patients on regular HD

Heart rate variability and cardiac autonomic dysfunction in hemodialysis patients with and without dialysis-induced hypotension

Background: Cardiac autonomic dysfunction [CAD] is a common problem in patients with hemodialysis [HD] and may contribute to the risk of cardiac mortality and dialysis-induced hypotension [DIH]. The aim of this study was to assess CAD by using heart rate variability [HRV] analysis in HD patients with and without DIH and to study its relationship with clinical characteristics and left ventricular [LV] function in those patients and to identify patients at high risk for DIH

Subjects and methods. Thirty regular HD patients with DIH and 32 HD patients without DIH and 30 age-and sex-matched healthy controls were enrolled in the study. All subjects underwent clinical and routine biochemical evaluations, echocardiography and 24-h ECG Holter recordings to determine HRV. We used time domain analysis of HRV for quantitative assessment of cardiac autonomic function

Results: All time-domain measures of HRV were significantly reduced in HD patients with and without DIH compared to healthy controls. HRV measures in patients with DIH were significantly reduced compared to patients without DIH, especially in those with ischemic heart disease [IHD] and diabetes mellitus. Significant correlations were found among time domain indices of HRV in patients with DIH and dialysis duration, diabetes, IHD and LV measures [LV end-systolic dimension, LV end-diastolic dimension, ejection fraction]. In a logistic regression model including clinical data and HRV measurements, ischemic heart disease and degree of [eh ventricular systolic dysfunction were found to be the strongest predictors of dialysis-related hypotension

Conclusions. Cardiac autonomic dysfunction [as manifested by decreased HRV] is frequent in HD patients and its degree may be enhanced in patients with DIH than in those without. Hemodialysis patients with reduced HRV, diabetes, or ischemic heart disease [IHD], and impaired left ventricular systolic function may be at the highest risk of hypotension during dialysis. Early detection and treatment of IHD and ventricular dysfunction and therapeutic measures to improve cardiac autonomic dysfunction in dialysis patients may have a role in preventing DIH in these patients