Echocardiographic Changes in Prevalent Hemodialysis Population Based on Cardiac Symptomatology

Abstract

BACKGROUND Despite the prevalence of cardiovascular complications in hemodialysis (HD) patients, routine screening for asymptomatic individuals remains underexplored in clinical practice, particularly beyond those assessed for kidney transplantation. This study aimed to investigate echocardiographic changes in prevalent HD patients, irrespective of symptomatic presentation. SUBJECTS AND METHODS A prospective, single-center study spanning 36 months included 79 HD patients. Grouping was based on cardiac symptomatology assessed with the New York Heart Association (NYHA) classification: group 1 comprised 18 asymptomatic patients (NYHA class I), while group 2 included 61 patients with moderate cardiac symptoms (NYHA classes II and III). Routine laboratory analyses, miRNA 133, hydration, and nutritional parameters were assessed, with echocardiography performed a day post-HD. RESULTS Demographic data, HD quality, blood pressure, therapy, and most echocardiographic indicators showed no significant differences. Asymptomatic patients exhibited noteworthy cardiac structural and functional abnormalities: 55.5% had left ventricular hypertrophy (LVH), and 72.2% had increased left atrial volume index (LAVi). Concentric hypertrophy was observed in 7/18 asymptomatic patients, while 15/61 symptomatic patients demonstrated concentric left ventricle remodeling. In comparison to group 2, group 1 displayed higher hemoglobin, uric acid, and miRNA 133 concentrations, along with better hydration control and higher lean tissue index. All these dependent variables show statistically significant relation to the NYHA: approximately 13% of the variance in Hb levels and 18% of the variance in miRNA can be explained by NYHA classification. CONCLUSION This study advocates for routine echocardiographic and cardiac examinations for all HD patients from the treatment's onset, irrespective of symptoms. Maintaining optimal volume, nutrition, urate concentrations, and hemoglobin is crucial for comprehensive cardiac care in this population. Additionally, exploring whether interventions targeting these non-cardiac factors could alleviate symptoms and improve quality of life in symptomatic HD patients would be worthwhile.