Blood pressure impact on left ventricular geometry in chronic haemodialysis patients.

AIM: Left ventricular hypertrophy in chronic haemodialysis patients is multifactorial. Our aim was to evaluate retrospectively the relationship between 24-h blood pressure monitoring and geometry and function of left ventricle (LV). Patients a methods: We examined 50 patients (men/women 33/17) treated by chronic haemodialysis (>3 months) aged 57.5 years (53-63; median, interquartile range). We measured blood pressure during 24 hours in short interdialytic period using Spacelab monitor 90217. Echocardiography was provided in short interdialytic period. RESULTS: Left ventricular mass index significantly correlated with SBP (tau-b=0.21; p=0.030; 95%CI 0.01-0.42), DBP (tau-b=0.23; p=0.018; 95%CI 0.04-0.42) and MAP (tau-b =0.26; p=0.009; 95%CI 0.06-0.45). SBP, DBP, MAP and PP did add a significant information to the prediction of relative wall thickness. We did not find any relationship between BP and left ventricular ejection fraction, left ventricular enddiastolic diameter and left atrial size. CONCLUSION: We found out an important 24-hour blood pressure impact on left ventricular relative wall thickness and left ventricular mass index. Left ventricular ejection fraction, left ventricular enddiastolic diameter and left atrial size were not related to 24-hour blood pressure. We did not find a relationship between blood pressure and left ventricular enddiastolic diameter. From all diastolic parameters the strongest association was found between systolic blood pressure in all three phases and ratio of peak early to late diastolic filling velocity (Tab. 5, Ref. 19).

[Blood pressure changes in chronically haemodialysed patients]. / Zmeny krvného tlaku u chronicky hemodialyzovaných pacientov.

BACKGROUND: Poor blood pressure control in chronically haemodialysed patients leads to increased cardiovascular morbidity and mortality. Information on valid values of blood pressure during haemodialysis and out of office is very important in order to set up adequate treatment. AIM: To measure blood pressure during the haemodialysis and the subsequent 24-hour period using an ambulatory blood pressure monitoring (ABPM) in patients with normal blood pressure (BP) and patients with high normal BP and hypertension. Relationship between time-dependent blood pressure changes, ultrafiltration (UF) and interdialytic weight gain (IDWG) was analysed. PATIENTS AND METHODS: Fifty chronically haemodialysed (> 3 months) patients (males/females 33/18) aged 57.5 (53-63; median, interquartile interval) years were studied. Systolic and diastolic pressures (SP, DP) were measured during haemodialysis every hour (H0-H4) and over following 24 hours using Spacelab 90217 monitor. Pulse pressure (PP) values were calculated as a difference between SP and DP. The patients were stratified into two groups based on the cut-off-point calculated as the mean of two mean arterial pressure (MAP) values obtained at the beginning and after the first hour of HD: Group A (n = 25), MAP < 100 mm Hg; Group B (n = 25), MAP 100 mm Hg. Interdialytic weight gain was measured before HD (IDWG1) and after the ABPM (IDWG2); also ultrafiltration (UF) was obtained. The post-dialysis 24-h ABPM period was divided into eight 3-hour intervals (M1-8). RESULTS: During HD no significant change in SP, DP or PP was found in both group, but there was a significant difference (p = 0.01) between both groups in SP, DP and PP. Values of BP at the end of dialysis were in group A: SP 125 (120-130) mm Hg, DP 75 (60-80) mm Hg and PP 50 (40-60) mm Hg in group B: SP 150 (140-160) mm Hg, DP 80 (80-90) mm Hg a PP 60 (60-70) mm Hg. We did not find any influence of IDWG1 or IDWG2 on SP or DP in both groups. Relationship between UF 3 000 (2 500-4 300) ml and SP (Δ sTK -5 mm Hg) was confirmed only in group A (p = 0.04). In group A, we found a decrease in SP during the third and sixth 3-hour interval (p = 0.01; p = 0.02) including sleeping period, all compared to the end of HD (H4). In group B, such a decrease in SP was found only in the second sleep interval (p = 0.01) and in the sixth 3-hour interval (p = 0.03), all compared to the end of HD (H4). As to DP at the end of dialysis (H4) in group A, it differed only in the third 3-hour interval (p = 0.02), but not during the sleeping period. In group B, the decrease of DP compared to the end HD (H4) was recorded during the two sleep intervals (p = 0.01), and also in the sixth and seventh 3-hour intervals (p = 0.01; p = 0.03). In group A, PP was compared to the end of HD (PPH4) significantly decreased in the first 3-hour interval (p = 0.02) and in seventh and eight 3-hour interval (p = 0.03; p = 0.04). In group B, PP did not significant change from the end of HD. Difference in SP between both groups was maintained over the entire course of ABPM (p = 0.01). However, DP values in both groups were different in the first and third 3-hour intervals (p = 0.01) but in following intervals DP in group B decreased to the level of that in group A. There was no significant difference in the proportion of non-dippers and reverse dippers in both groups. CONCLUSION: Systolic, diastolic, mean arterial and pulse pressure pressures were not significantly changed during the haemodialysis in both groups. Relationship between ultrafiltration and systolic pressure was confirmed only in group A. No influence of interdialytic weight gain on blood pressure during 24 hours was seen in either group. Systolic pressure decreased in both groups during the nighttime compared to post-HD values, but diastolic pressure decreased only in group B. PP did not decrease during the night in any group. There was no significant difference in the proportion of non-dippers and reverse dippers in both groups.

Relation of ventricular late potentials and intradialytic changes in serum electrolytes, ultrafiltration, left ventricular ejection fraction and left ventricular mass index in haemodialysis patients.

BACKGROUND: End-stage renal failure patients on haemodialysis (HD) suffer from increased risk of sudden cardiac death. Abnormal late potentials (LP) on signal-averaged electrocardiogram (SAAECG) has proved valuable for identification of increased risk of malignant ventricular tachyarryhythmias in various settings of patients. Abnormalities in LP were reported in HD patients, but their role is still not clear. The aim of the study was to evaluate: 1. the influence of HD on SAECG, 2. the correlation of intradialytic changes of serum electrolytes, weight change and ultrafiltration with intradialytic changes of LP, 3. the correlation of left ventricular ejection fraction (LVEF) and left ventricular mass index (LVMI) with LP before and after HD. METHODS: LP (parameters fQRSd, RMS40, LAS40) were obtained in 39 patients in sinus rhythm within one hour before and after chronic maintenance HD. Patients with permanent atrial fibrillation or on antiarrhythmic therapy (other than betablockers) were excluded. Echocardiography was performed within three days before HD. RESULTS: No difference in fQRSd before and after HD was found. Postdialytic RMS40 (47.0 +/- 30.1 microV vs 37.1 +/- 22.6 microV, p < 0.05) and LAS40 (25.9 +/- 9.7 ms vs 30.8 +/- 12.5 ms, p < 0.05) significantly improved. Weak significant negative correlation between intradialytic Na change and fQRSd change was found (R = -0.33, p < 0.05). Correlations between intradialytic changes of other electrolytes (K, Ca, P. Mg) and individual LP parameters were nonsignificant. There was no correlation found between intradialytic weight change/ultrafiltration and intradialytic differencies of SAECG. LVEF was weakly inversely correlated with predialytic fQRSd (R = -0.37, p < 0.05) and postdialytic fQRSd (R = -0.35, p < 0.05). LVMI was weakly positively correlated with predialytic fQRSd (R=0.39, p < 0.05) and postdialytic fQRSd (R = 0.40, p < 0.05). LVEF respectively LVMI did not correlate neither with RMS40 nor with LAS40 before or after HD. CONCLUSIONS: SAECG partially improved in end-stage renal failure patients after HD (RMS40 and LAS40 but not fQRSd). Intradialytic differencies of SAECG were not correlated neither with ultrafiltration nor with weight change. Pre-/postdialytic fQRSd inversely correlated with LVEF and positively correlated with LVMI. Further controlled, prospective studies investigating the impact of LP on HD patient care are needed. (Tab. 6, Ref. 19.).

[Serum cystatin C in haemodialysed patients]. / Cystatín C v sére u hemodialyzovaných pacientov.

BACKGROUND: Cystatin C (CyC) is protein (m. w. 13 300), which is produced by nucleated cells, filtered through glomeruli and subsequently reabsorbed and degraded in tubuli. OBJECTIVE: To investigate changes in serum CyC concentration during two low-flux membrane haemodialyses (HD-I, HD-II) and relationship between serum CyC a creatinine concentrations. PATIENTS AND METHODS: Serum CyC was determined in 17 patients on chronic haemodialysis during HD-I and HD-II by immunonephelometric method (Dade Behring, Austria). RESULTS: Significant correlation between serum CyC and creatinine before HD-I and before/after HD-II was found (p < 0.001). Serum CyC before HD-I (median 6.3 mg/I, 95 % CI 5.5 - 6.7) increased after HD-I (7.1 mg/l, 6.1 - 8.9) (p < 0.001). Serum CyC before HD-II (6.4 mg/l, 5.8 - 7.2) increased after HD-II (8.0 mg/l, 7.3 - 9) (p < 0.001), while serum creatinine decreased after HD-I and HD-II (p < 0.001). There was correlation between the increase in serum CyC and albumin during HD-I (p < 0.001) and HD-II (p < 0.01). CONCLUSION: There was close correlation between serum CyC and creatinine before haemodialyses. Serum CyC increased after haemodialyses, due to CyC non-dialysability through low-flux membrane and haemoconcentration. Unlike creatininaemia, serum CyC reflects the residual renal function even after haemodialyses.

[Thyroid gland function after short-term administration of amiodarone and digoxin]. / Funkcia stítnej zl'azy po krátkodobom podávaní amiodaronu a digoxínu.

The authors administered to 13 patients with auricular fibrillation amiodarone (Cordarone), 1200 mg/day, by the oral route from the 4th to the 10th day of the trial, 600 mg per day from the 11th to the 13th day of the trial. Simultaneously the patients were given digoxin, 1 mg, by the i.v. route: on the first day 1 mg i.v., 2nd to 5th day 0.5 mg i.v., and on the 6th to 10th day of the trial 0.25 mg. They assessed the serum digoxin concentration on the 1st, 4th, 11th and 14th day, the serum concentration of triiodothyronine (T3), thyroxine (T4) and thyrotropic hormone (TSH) on the 1st and 14th day of the trial. The authors revealed that after ten days administration of amiodarone T4 does not change (102.4 +/- 28.2 nmol/l vs. 101.3 +/- 13.4 nmol/l, NS), T3 declines significantly (2.47 +/- 0.85 nmol/l vs. 1.86 +/- 0.54 nmol/l, p less than 0.001) and TSH rises insignificantly (2.82 +/- 1.18 mU/l vs. 3.34 +/- 1.43, NS). Consistent with data in the literature on the effect of several weeks administration of amiodarone on thyroid function, the authors assume inhibition of 5'monodeiodization of T4 with a reduced formation of T3 and increased formation of rT3. The drop of T3 may play a part also in the antiarrhythmic action of amiodarone in the treatment of auricular fibrillation.