Investigation Of The Change Of Cardiac Function And Struction And Analysis Of Associated Factors In Patients With Hypertension During Maintaining Hemodialysis

Objectives: The objectives of this study were to investigate the changes of cardiac function and structure in patients with end-stage renal disease during maintenance hemodialysis, and to determine the role of hypertension and its associated factors in these patients during hemodialysis.Methods: 48 end-stage renal disease patients requiring maintenance dialysis were selected and divided into two groups based on their blood pressure. Group A included 18 patients with refractory hypertension. 30 patients with controlled hypertension were included in Group B. 20 healthy volunteers were enrolled in Group C and used as controls. Monitoring index after patient selection and 6 months later were: ultrasonic and hemodynamic evaluation. Ultrasonic study included: (1) left atrial diameter systolic (LADS), left ventricular end diastolic dimension (LVEDD), interventricular septal thickness (IVS), left ventricular posterior wall thickness (LVPW), ejection fraction (EF), ratio of early mitral inflow peak velocity and atrial mitral inflow peak velocity (E/A), ejection fraction (EF), and calculated left ventricle mass (LVM), and left ventricle mass index (LVMI), (2) standard of Integral Backscatter (IBS%) of myocardium, cyclic variation of IBS (CVIB). Hemodynamic monitor included thoracic fluid content (TFC), systemic vascular resistance (SVR), cardiac index (CI), cardiac accelerate index (ACI), mean arterial pressure (MAP), systolic blood pressure (SBP), and diastolic blood pressure (DBP).Results: 1: Echocardiogram studies showed that both cardiac structure and function in patients with MHD were abnormal. (1) In the initial stage of this study, the index reflecting cardiac structure such as LADS, LVEDD, IVS, LVPW, LVM, LVMI were significantly higher in Group A and B when compared with Group C. The index inGroup A is significantly higher than Group B. Moreover, the aggravated cardiacstructures induced by hypertension were observed. After 6 months intervention, theblood pressure, dry weight and interdialysis weight gain in Group A decreasedsignificantly. Cardiac structure in both Group A and B were improved markedly.Moreover the improvement in Group A is obviously better when compared withpre-intervention. (2) In the initial phase of this study, the EF, ACI, and CVIB thatreflecting cardiac systole function, were significantly lower in both Group A and Bthan Group C. In addition, the index in Group A was lower than Group Bsignificantly indicating that hypertension can aggravate cardiac systole function.E/A, reflecting cardiac diastolic function, was significantly lower in both Group Aand B than Group C. There was no significant difference observed between Group Aand B. After 6 months intervention, the pressure, dry weight and interdialysisweight gain descended significantly in group A. Cardiac function was improved inboth Group A and B, and a significant improvement was noted in Group A thanGroup B. (3) In the initial stage of this study, IBS (%), the index reflectingmyocardium change, were higher in Group A and B than Group C significantly. Inaddition, IBS (%) in Group A is higher than Group B significantly suggesting that thehypertension aggravate myocardium change. 6 months after intervention, cardiacfunction In Group A was improved but without statistic significance when comparedwith Group B. 2: In the initial stage of study, SVR and TFC, both reflecting waterload and vascular resistance were higher in Group A and B than Group C significantly.Moreover Group A was higher obviously than Group B suggesting that high waterload and vascular resistance can induce hypertension. After 6 months intervention,water load and vascular resistance in Group A and B were decreased, and a dramaticreduction in Group A was noted when compared to pre-intervention. 3: bloodpressure, TFC, IDWG, and HGB correlated well with changes of cardiac structure andfunction. Additionally, TFC and IDWG correlated well with blood pressure, whichwere the important factors effect the blood pressure during the maintenance ofhemodialysis patients. Conclusion (1) There are high rates of abnormalities regarding cardiac structure and function in end-stage renal disease patients requiring maintenance dialysis, and the severity of abnormalities is associated with hypertension. (2) patients with Maintenance hemodialysis coincidenceing hypertension have high water load widespread, and high water load is the independent risk factor. (3) Determine correct dry weight and ultrafiltration can improved obviously high volume load and pressureload to maintenance hemodialysis patients, furthermore can improved their cardiacstructure and function.