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Intradialytic Cardiac Magnetic Resonance Imaging to Assess Cardiovascular Responses in a Short-Term Trial of Hemodiafiltration and Hemodialysis

Buchanan, Charlotte; Mohammed, Azharuddin; Cox, Eleanor; Köhler, Katrin; Canaud, Bernard; Taal, Maarten W.; Selby, Nicholas Michael; Francis, Susan T.; McIntyre, Christopher W.

Authors

Charlotte Buchanan charlotte.buchanan@nottingham.ac.uk

Azharuddin Mohammed

Eleanor Cox eleanor.cox@nottingham.ac.uk

Katrin Köhler

Bernard Canaud

Maarten W. Taal

Nicholas Michael Selby

Susan T. Francis susan.francis@nottingham.ac.uk

Christopher W. McIntyre



Abstract

Hemodynamic stress during hemodialysis (HD) results in recurrent segmental ischemic injury (myocardial stunning) that drives cumulative cardiac damage. We performed a fully comprehensive study of the cardiovascular effect of dialysis sessions using intradialytic cardiac magnetic resonance imaging (MRI) to examine the comparative acute effects of standard HD versus hemodiafiltration (HDF) in stable patients. We randomly allocated 12 patients on HD (ages 32–72 years old) to either HD or HDF. Patients were stabilized on a modality for 2 weeks before undergoing serial cardiac MRI assessment during dialysis. Patients then crossed over to the other modality and were rescanned after 2 weeks. Cardiac MRI measurements included cardiac index, stroke volume index, global and regional contractile function (myocardial strain), coronary artery flow, andmyocardial perfusion. Patients had mean6SEMultrafiltration rates of 3.862.9 ml/kg per hour during HD and 4.462.5 ml/kg per hour during HDF (P=0.29), and both modalities provided a similar degree of cooling. All measures of systolic contractile function fell during HD and HDF, with partial recovery after dialysis. All patients experienced some degree of segmental left ventricular dysfunction, with severity proportional to ultrafiltration rate and BP reduction. Myocardial perfusion decreased significantly during HD and HDF. Treatment modality did not influence any of the cardiovascular responses to dialysis. In conclusion, in this randomized, crossover study, there was no significant difference in the cardiovascular response to HDF or HD with cooled dialysate as assessed with intradialytic MRI.

Journal Article Type Article
Publication Date 2017-04
Journal Journal of the American Society of Nephrology
Print ISSN 1046-6673
Electronic ISSN 1533-3450
Publisher American Society of Nephrology
Peer Reviewed Peer Reviewed
Volume 28
Issue 4
Pages 1269-1277
APA6 Citation Buchanan, C., Mohammed, A., Cox, E., Köhler, K., Canaud, B., Taal, M. W., …McIntyre, C. W. (2017). Intradialytic Cardiac Magnetic Resonance Imaging to Assess Cardiovascular Responses in a Short-Term Trial of Hemodiafiltration and Hemodialysis. Journal of the American Society of Nephrology, 28(4), 1269-1277. https://doi.org/10.1681/ASN.2016060686
DOI https://doi.org/10.1681/ASN.2016060686
Keywords Haemodialysis, haemodiafiltration, cardiac stunning, randomised controlled trial, cardiac MRI
Publisher URL https://jasn.asnjournals.org/content/28/4/1269
Copyright Statement Copyright information regarding this work can be found at the following address: http://eprints.nottingh.../end_user_agreement.pdf

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://eprints.nottingham.ac.uk/end_user_agreement.pdf





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