Modification of frequency and severity of myocardial ischemia during hemodialysis by transdermal application of nitroglycerine in patients with end stage renal disease

ABSTRACT

Previous reports demonstrated that hemodialysis [HD] may predisprose to myocardial ischemia by simultaneous interplay of hypotension, hypovolemia, hypoxia and tachycardia. 12 patients were studied with coronary heart disease [CHD] and end stage renal disease [ESRD] by ambulatory ECG recording HD both before and after transdermal application of 5 mg nitroglycerine [NG] patches [Nitroderm, Ciba]. Application of NG 2 hours before HD resulted in reduction of number of painful ischemic episodes [from 2.25 +/- 1.81 to 1.16 +/- 1.4, p=NS], number of silent ischemic episodes [from 9.08 +/- 7.45 to 1.41 +/- 2.81, p <0.003], maximum ST depression [from 2.08 +/- 0.99 to 0.83 +/- 0.93 m2] p <0.0001], maximum ST elevation [from 1.66 +/- 0.77 to 1.25 +/- 0.62 mm, p=NS], total ischemia time [from 71.9 +/- 92.7 to 11.5 +/- 31.8 minutes, p <0.03], duration of longest ST shift [from 15.6 +/- 15.5 to 5 +/- 0.1 minutes, P <0.03], while there was no difference in mean blood pressure [from 100 +/- 7 to 98 +/- 6 mmHg, p=NS] or mean heart rate from 96 +/- 9 to 92 +/- 10, P=NS]. It was concluded that total ischemic burden [symptomatic and silent episodes] is decreased considerably in patients with CHD and ESRD by application of 5 mg transdermal NG 2 hours before HD without considerable side effects