Background: Repeated inter-dialysis water retention contributes to the development of left ventricular hypertrophy and failure, which is responsible for significant mortality of end-stage renal disease (ESRD) patients. The left atrium has a thin wall, which makes it even more prone to preload changes. In the general population with heart failure with preserved ejection fraction (HFpEF), left atrial function is even worse than that in patients with reduced ejection fraction. We hypothesized that repeated water retention is related to left atrial dysfunction in ESRD patients treated by hemodialysis and that the expected changes would be related to the brain natriuretic peptide (BNP) levels. Methods: Forty six patients were enrolled. Left atrial end-diastolic and end-systolic volumes and left atrial ejection fraction (LAEF) were recorded by echocardiography just before and just after dialysis and then analyzed offline. Moreover, BNP was analyzed also prior to dialysis and after. Effects of dialysis were tested using paired t test and the correlation analysis was applied to test associations. Results: LAEF was inversely related to the dialysis vintage (r = -0.62, p = 0.001) and patient's age (r = -0.48, p = 0.005) and it did not increase after dialysis despite the decrease of left atrial volume. BNP was related to left atrial volume index (r = 0.45, p = 0.019) and to LAEF (r = -0.57, p = 0.003). Conclusions: LAEF is decreased especially in long-term dialyzed patients and does not improve after dialysis despite the decrease of left atrial volume. Inadequate contractility reserve of the left atrium is similar to the non-ESRD patients with HFpEF and might help explain the high prevalence of heart failure in ESRD patients.

Keywords:
Heart failure, End-stage renal disease, Dialysis, Left atrium, Echocardiography
1.
Malik J, Tuka V, Mokrejsová M, Holaj R, Tesar V: Mechanisms of chronic heart failure development in end-stage renal disease patients on chronic hemodialysis. Physiol Res 2009;58:613-621.
2.
Aitken E, Kerr D, Geddes C, Berry C, Kingsmore D: Cardiovascular changes occurring with occlusion of a mature arteriovenous fistula. J Vasc Access 2015;16:459-466.
3.
Braunwald E, Brockenbrough EC, Frahm CJ, Ross J Jr: Left atrial and left ventricular pressures in subjects without cardiovascular disease: observations in eighteen patients studied by transseptal left heart catheterization. Circulation 1961;24:267-269.
4.
Kim SJ, Han SH, Park JT, Kim JK, Oh HJ, Yoo DE, et al: Left atrial volume is an independent predictor of mortality in CAPD patients. Nephrol Dial Transplant 2011;26:3732-3739.
5.
Ozdogan O, Kayikcioglu M, Asci G, Ozkahya M, Toz H, Sezis M, et al: Left atrial volume predicts mortality in low-risk dialysis population on long-term low-salt diet. Am Heart J 2010;159:1089-1094.
6.
Omae K, Ogawa T, Yoshikawa M, Nitta K: Left atrial dilatation and ST-T changes predict cardiovascular outcome in chronic hemodialysis patients. Heart Vessels 2012;27:610-617.
7.
Tanaka A, Inaguma D, Shinjo H, Murata M, Takeda A; Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis (AICOPP) Study Group: Presence of atrial fibrillation at the time of dialysis initiation is associated with mortality and cardiovascular events. Nephron 2016;132:86-92.
8.
Palecek T, Skalicka L, Lachmanova J, Tesar V, Linhart A: Effect of preload reduction by hemodialysis on conventional and novel echocardiographic parameters of left ventricular structure and function. Echocardiography 2008;25:162-168.
9.
Melenovsky V, Hwang SJ, Redfield MM, Zakeri R, Lin G, Borlaug BA: Left atrial remodeling and function in advanced heart failure with preserved or reduced ejection fraction. Circ Heart Fail 2015;8:295-303.
10.
Spanaus KS, Kronenberg F, Ritz E, Schlapbach R, Fliser D, Hersberger M, et al; Mild-to-Moderate Kidney Disease Study Group: B-type natriuretic peptide concentrations predict the progression of nondiabetic chronic kidney disease: the mild-to-moderate kidney disease study. Clin Chem 2007;53:1264-1272.
11.
Svensson M, Gorst-Rasmussen A, Schmidt EB, Jorgensen KA, Christensen JH: NT-pro-BNP is an independent predictor of mortality in patients with end-stage renal disease. Clin Nephrol 2009;71:380-386.
12.
Dernellis JM, Stefanadis CI, Zacharoulis AA, Toutouzas PK: Left atrial mechanical adaptation to long-standing hemodynamic loads based on pressure-volume relations. Am J Cardiol 1998;81:1138-1143.
13.
Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G, et al: Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese society of echocardiography. Eur J Echocardiogr 2011;12:167-205.
14.
Kudlicka J, Kavan J, Tuka V, Malik J: More precise diagnosis of access stenosis: ultrasonography versus angiography. J Vasc Access 2012;13:310-314.
15.
Khan A, Moe GW, Nili N, Rezaei E, Eskandarian M, Butany J, et al: The cardiac atria are chambers of active remodeling and dynamic collagen turnover during evolving heart failure. J Am Coll Cardiol 2004;43:68-76.
16.
Wang AY, Wang M, Lam CW, Chan IH, Lui SF, Sanderson JE: Heart failure with preserved or reduced ejection fraction in patients treated with peritoneal dialysis. Am J Kidney Dis 2013;61:975-983.
17.
Bossola M, Pellu V, Di Stasio E, Tazza L, Giungi S, Nebiolo PE: Self-reported physical activity in patients on chronic hemodialysis: correlates and barriers. Blood Purif 2014;38:24-29.
18.
Abid L, Charfeddine S, Kammoun S: Relationship of left atrial global peak systolic strain with left ventricular diastolic dysfunction and brain natriuretic peptide level in end-stage renal disease patients with preserved left ventricular ejection fraction. J Echocardiogr 2016;14:71-78.
19.
Leischik R, Littwitz H, Dworrak B, Garg P, Zhu M, Sahn DJ, et al: Echocardiographic evaluation of left atrial mechanics: function, history, novel techniques, advantages, and pitfalls. Biomed Res Int 2015;2015:765921.
20.
Ishigami J, Iimori S, Kuwahara M, Sasaki S, Tsukamoto Y: Diagnostic value of B-type natriuretic peptide for estimating left atrial size and its usefulness for predicting all-cause mortality and cardiovascular events among chronic haemodialysis patients. Nephrology (Carlton) 2014;19:777-783.
21.
Fagugli RM, Palumbo B, Ricciardi D, Pasini P, Santirosi P, Vecchi L, et al: Association between brain natriuretic peptide and extracellular water in hemodialysis patients. Nephron Clin Pract 2003;95:c60-c66.
22.
Cataliotti A, Malatino LS, Jougasaki M, Zoccali C, Castellino P, Giacone G, et al: Circulating natriuretic peptide concentrations in patients with end-stage renal disease: role of brain natriuretic peptide as a biomarker for ventricular remodeling. Mayo Clin Proc 2001;76:1111-1119.
23.
Niizuma S, Iwanaga Y, Yahata T, Tamaki Y, Goto Y, Nakahama H, et al: Impact of left ventricular end-diastolic wall stress on plasma B-type natriuretic peptide in heart failure with chronic kidney disease and end-stage renal disease. Clin Chem 2009;55:1347-1353.
24.
Kanno T, Kamijo Y, Hashimoto K, Kanno Y: Outcomes of blood flow suppression methods of treating high flow access in hemodialysis patients with arteriovenous fistula. J Vasc Access 2015;16(suppl 10):S28-S33.
© 2016 S. Karger AG, Basel
2016
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.