Clinical study of the cardiac findings in patients on chronic maintenance hemodialysis: the relationship to coronary risk factors
Friedman, H.S.; Shah, B.N.; Kim, H.G.; Bove, L.A.; Del Monte, M.M.; Smith, A.J.
Clinical Nephrology 16(2): 75-85
1981
ISSN/ISBN: 0301-0430 PMID: 7261485 Document Number: 175626
To assess cardiac function in patients on hemodialysis, 15 men and 12 women (44 .+-. 3 years) on hemodialysis for 1.7 .+-. 0.3 yr were studied. Ten patients had angina pectoris; 16 had congestive heart failure and were receiving digitoxin therapy. Patients [20] had a history of hypertension, but only in 8 was therapy required after beginning hemodialysis. Twenty-one patients had systolic murmurs; in 4 the murmur was loud, long, harsh and musical and associated with dense aortic root echoes. No diastolic murmurs or pericardial friction rubs were heard. Twenty-four hour Holter ECG showed > 30/h ventricular premature beats in 8 patients and/or > 30/h atrial premature beats in 7. In 6 patients ventricular premature beats and/or atrial premature beats > 30/h occurred during hemodialysis. Arrhythmias were not associated with digitoxin therapy but were associated with left ventricular wall abnormalities. Compared to normals, 25 patients had larger aortic roots (P < 0.025) left atria (P < 0.001), left ventricular internal dimensions (P < 0.005) and left ventricular wall thickness (P < 0.001); cardiac output was greater (5.6 .+-. 0.5 vs. 4.5 .+-. 0.31/min). Eleven of 25 patients had left ventricular dysfunction; 8 of these patients had akinesia or dyskinesia. Twenty patients had cardiomegaly, but only 5 had an echo-free space suggesting pericardial effusion. Seven of the 27 patients died. Four deaths appeared to be caused by heart disease but noncardiac complications were present in 6. Six of the patients who died had angina and all had hypertension, congestive heart failure and left ventricular asynergy; 4 had dense aortic root echoes. Of the coronary risk factors analyzed, only hypertension was significantly related to cardiac abnormalities. A relationship between the presence of aortic root calcification and cardiac morbidity and mortality was suggested. Cardiac abnormalities, detectable by noninvasive methods are common in patients on maintenance hemodialysis and these findings have prognostic implications.