Echocardiographic parameters in patients with and without hypotension during dialysis

Hypotension during dialysis is a common complication of hemodialysis and is associated with increased patient mortality and morbidity. Intradialytic hypotension is a decrease in systolic BP ≥20 mm Hg or a reduction in mean arterial pressure by 10 mm Hg along with clinical events and the need for correction. This study compares cardiac function, using transthoracic echocardiography with strain modality in patients with intradialytic hypotension with those without hypotension during dialysis.

We studied 60 patients with chronic renal failure undergoing regular hemodialysis from April 2018 to February 2019. We compared thirty patients in the intradialytic hypotension group, with the remaining 30 patients in the control group. We did transthoracic echocardiography a day after hemodialysis using conventional, tissue doppler, and strain imaging.

Early diastolic mitral annulus velocity (e’) was lower in the intradialytic hypotension group in comparison with the control group which their difference was statistically significant (5.540±1.51 versus 6.920±1.98, P value:0.007) Left Ventricular Ejection Fraction (LVEF) was also significantly lower in the intradialytic hypotension group (51.07± 8.714 versus 59.43±4.133, P value<0.001). Global Longitudinal Strain (GLS) was significantly lower in the intradialytic hypotension group (-14.17±2.79 versus -18.99± 2.25, P value<0.001). The receiver operator characteristics (ROC) curve point-coordinates that GLS of -16.85 and lower (more positive) has 83% sensitivity and 87% specificity for intradialytic hypotension.

The echocardiographic assessment could be used as a tool for the prediction of hypotension during dialysis.