Effects of predilution hemodiafiltration-induced intradialytic left ventricular systolic dysfunction compared to high-flux hemodialysis

Purpose Hemodialysis (HD)-induced myocardial ischemia may lead to left ventricular (LV) dysfunction after normal perfusion returns. This study aimed to assess the short-term influence of predilution hemodiafiltration (HDF) and high-flux hemodialysis (HD) on intradialytic LV systolic function, and hematologic and biochemical risk factors. Methods This cross-over clinical trial enrolled 38 dialysis patients who were randomized equally into one of two treatment sequences: 1-week predilution HDF treatment followed by 1-week high-flux HD, and vice versa. LV systolic function was assessed by echocardiography before and after the mid-week dialysis session. Hematologic and biochemical parameters were also measured. Replacement fluid volume for all patients was 24.2 +/- 1.3 L/session. Results Subjects' mean age was 53.3 +/- 11.8 years and 24 were males. LV ejection fraction (LVEF) decreased from 61.31 +/- 9.96 to 59.03 +/- 10.37% after HDF (P = 0.016), and increased from 61.69 +/- 11.08 to 62.72 +/- 11.26% after high-flux HD (P = 0.190). Average of peak LV systolic tissue velocity increased from 6.74 +/- 1.23 to 6.98 +/- 1.56 cm/s after HDF (P = 0.246), and increased from 6.71 +/- 1.34 to 7.44 +/- 2.18 cm/s (P = 0.039) after high-flux HD. The ratio between peak LV early diastolic mitral inflow velocity and peak LV early diastolic tissue velocity (E/E ') at the septal mitral annulus decreased to 18 +/- 9 from 21 +/- 11 (P = 0.147) after HDF, and to 17 +/- 8 from 20 +/- 8 (P = 0.037) after high-flux HD. beta 2-microglobulin was reduced more during HDF than during high-flux HD (70.7 +/- 5.3 vs. 67.7 +/- 3.9%, P < 0.001). Conclusion Predilution HDF decreases intradialytic LV systolic function more than high-flux HD. Randomized controlled trials with a larger multi-center sample and long-term follow-up are required to demonstrate the potential mechanisms of predilution HDF effecting on ventricular function.