Evaluation of echocardiographic variables in patients of chronic renal failure: pre and post hemodialysis-a single center prospective study

Gaurav Garg, Devinder K. Vohra, Sharvan Kumar, Ganesh Singh, Alka Srivastava


Background: Cardiovascular disease is the leading cause of morbidity and mortality at each stage of Chronic Kidney Disease (CKD) around 30%-45% of patients of stage 5 CKD have advanced cardiovascular complications. Congestive Heart Failure is responsible for approximately 15% death in hemodialysis patients. Hence this study was done with the aim to evaluate the effects of Hemodialysis on various Cardiac parameters detected by 2D Echocardiography in patients with Chronic Kidney Disease.

Methods: In this prospective cohort study, 54 patients with Stage 4 and 5 CKD were evaluated for various cardiac parameters by 2D Echocardiography before and after Hemodialysis and detailed characteristics of the patients were analyzed using SPSS version 16 and paired student t-test.

Results: Among 54 patients with CKD, 9% (5/54) patients had stage 4 CKD while 91% (49/54) had stage 5 CKD. Hypertension was present in 81.48% (44/54) of patients and Left ventricular hypertrophy was present in 77.77% (42/54). 6 (11%) patients had associated pericardial effusion. Mean Pre and Post Hemodialysis Left ventricular end diastolic diameter (LVIDed) and Left ventricular end systolic diameter (LVIDes) was 50.38±4.16mm and 48.91±4.14mm; 33.54±3.29 mm and 32.58±2.80 mm respectively which was statistically significant (p <0.001). Pre-HD Left atrial diameter was 34.20±3.81mm and it became 33.19±3.30mm Post-HD (p <0.001). Left ventricular mass index (LVMI) was 136.70±35.91 g/m2 pre-HD and 125.54±29.35 g/m2 post-HD which is significant. Left Ventricular Ejection Fraction was 47.34±5.72% before HD and it became 48.82±4.56% after 6 session of Hemodialysis over 3 weeks which is statistically significant (p<0.038).

Conclusions: The present findings suggest patients with Stage 4 and 5 CKD who were on hemodialysis there was significant improvement in various cardiac parameters apart from increase in left ventricular ejection fraction, which may lead to decrease morbidity and mortality in these patients.


Chronic kidney disease, Hemodialysis, Left ventricular mass index, Left ventricular ejection fraction

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Levey AS, Stevens LA, Coresh J. Conceptual model of CKD, applications and implications. Am J Kidney Dis. 2009; 53:S4-16.

KDIGO AKI Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney inter. Suppl. 2012;2:1-138.

Ravera M, Rosa GM, Fontanive P, Bussalino E, Dorighi U, Picciotto D, et al. impaired left ventricular global longitudinal strain among patients with chronic kidney disease and end-stage renal disease and renal transplant recipients. Cardiorenal Med. 2019;9(1):61-8.

Chan C, Floras JS, Miller JA, Pierratos A. Improvement in ejection fraction by nocturnal haemodialysis in end‐stage renal failure patients with coexisting heart failure. Nephrol Dialysis Transplantation. 2002 Aug 1;17(8):1518-21.

Martin LC, Barretti P, Cornejo IV, Felipe MJ, Forti AH, Matsubara BB, et al. Influence of fluid volume variations on the calculated value of the left ventricular mass measured by echocardiogram in patients submitted to hemodialysis. Renal Failure. 2003 Jan 1;25(1):43-53.

Kunz K, Dimitrov Y, Muller S, Chantrel F, Hannedouche T. Uraemic cardiomyopathy. Nephrol Dial Transplant. 1998;13(Suppl4):39-43.

Levine A, Singer J, Thompson CR, Ross H, Lewis M. Prevalent left ventricular hypertrophy in the predialysis population: identifying opportunities for intervention. Am J Kidney Dis. 1996;27:347-54.

Agarwal S, Dangri P, Kalra OP, Rajpal S. Echocardiographic assessment of cardiac dysfunction in patients of chronic renal failure. JIACM. 2003 Oct;4(4):297.

Laddha M, Sachdeva V, Diggikar PM, Satpathy PK, Kakrani AL. Echocardiographic assessment of cardiac dysfunction in patients of end stage renal disease on haemodialysis. JAPI. 2014;62(1):28-32.

Zoccali C, Benedetto FA, Mallamaci F, Tripepi G, Giacone G, Cataliotti A, et al. Prognostic value of echocardiographic indicators of left ventricular systolic function in asymptomatic dialysis patients. J Am Soc Nephrol. 2004;15:1029-37.

Hung J, Harris PJ, Uren RF, Tiller DJ, Kelly DT. Uremic cardiomyopathy-effect of hemodialysis on left ventricular function in end-stage renal failure. New England J Med. 1980 Mar 6;302(10):547-51.

Galetta F, Cupisti A, Franzoni F, Carpi A, Barsotti G, Santoro G. Acute effects of hemodialysis on left ventricular function evaluated by tissue Doppler imaging. Biomed Pharmacother. 2006;60:66-70.

Bjällmark A, Larsson M, Nowak J, Lind B, Hayashi SY, Do Nascimento MM, et al. Effects of hemodialysis on the cardiovascular system: quantitative analysis using wave intensity wall analysis and tissue velocity imaging. Heart Vessels. 2011 May 1;26(3):289-97.

Hensen LC, Goossens K, Delgado V, Abou R, Rotmans JI, Jukema JW, et al. Prevalence of left ventricular systolic dysfunction in pre‐dialysis and dialysis patients with preserved left ventricular ejection fraction. Euro J Heart Failure. 2018 Mar;20(3):560-8.

Ganda A, Weiner SD, Chudasama NL, Valeri AM, Jadoon A, Shimbo D, et al. Echocardiographic changes following hemodialysis initiation in patients with advanced chronic kidney disease and symptomatic heart failure with reduced ejection fraction; Clin Nephrol. 2012 May;77(5):366-75.

Nixon JV, Mitchell JH, McPhaul JJ, Henrich WL. Effect of hemodialysis on left ventricular function. Dissociation of changes in filling volume and in contractile state. J Clin Investigation. 1983 Feb 1;71(2):377-84.