A HEMODY1VAIVIIC AND ECHO-DOPPLER ASSESSMENT OF THE EFFECTS OF DIALYSIS AR.TERIO-VENOUS FISTULA AND ACUTE EFFECTS OF HEMODIALYSIS ON CARDIAC PERFORMANCE IN PATIENTS WITH END STAGE RENAL FAILURE
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The present study examined prospectively the effects of creation of dialysis arteriovenous fistula (AVF) and also the effects of hemodialysis on cardiac performance. 30 patients with end stage renal failure scheduled for chronic hemodialysis were included. They were classified into two groups: group A:15 patients with distal AVF in the forearm and group B: 15 patients with proximal AVF in the upper arm. The effects of fistula creation on cardiac performance was studied by comparing echocardiographic data before and 2 weeks after fistula crew don. In group A: ejection fraction (EF7 increased by 4.3+ 2.4 (P<0.01). fractional shortening (FS) increased by 3.9+2.3 (P<0.01) and the cardiac index (CI) increased by 0.72+0.15 (P<0.01). Systemic vascular resistance (SW?) decreased by 5.75+2.3 (P<0.01). In group B : EF increased by 4.34+2.5 (P<0.01), FS increased by 3.2+2.76 (P<0.01) and CI increased by 0.81+0.46 (P<0.01). SVR decreased by 5.91+3.6 (P<0.01). There was no significant change in heart rate (HR), mean arterial pressure (MAP). end systolic diameter (ESD) and end systolic volume (ES')) in both groups. The acute effects of dialysis on systolic and diastolic left ventricular (LV) function was studied by comparing echo-doppler data after 2 weeks of fistula creation before and after dialysis. In group A : SV decreased by 9.8+8.2 (P<0.01). CI decreased by 0.87+0.76 (P<0.05) and MAP de- ceased by 10.1+3.4 (P<0.01). HR increased by 5.6+2.8 (P<0.01) and SVR increased by 3.4+2.8 (P<0.05). The E wave velocity decreased from 90+28 to 79+31c m/s (P<0.05). The E/A ratio decreased from 1.05 + 0.5 to 0.89+0.5 (P<0.05). In group B : SV decreased by 14.1+2.3 (P<0.01), CI decreased by 0.62+0.34 (P<0.01) and MAP decreased by 7.2+3.4 (P<0.01). HR increased by 5.2+3.6 (P<0.01), SVR increased by 2.3+1.8 (P<0.05). The E wave velocity decreased from 93+34 to 80+37 cm/ s (P<0.05). The E/A ratio decreased from 1.04+0:7 to 0.86+0.5 (P<0.05). There was no signcant change in EF and FS in both groups. Also the A wave velocity and deceleration time showed insignificant increase.