The effect of intensive hemodialysis on pulmonary arterial pressure and left ventricular systolic function in patients with end-stage renal disease; a prospective clinical trial

Abstract

Introduction: End-stage renal disease (ESRD) requires hemodialysis or kidney transplantation for the patients to survive. Objectives: The present study was conducted to examine whether intensive hemodialysis and hemoglobin (Hb) concentration correction can improve left ventricular (LV) function and pulmonary arterial hypertension in ESRD patients? Patients and Methods: This prospective clinical trial was designed to examine patients referring to public hospitals in Ahvaz, Iran, in 2016-2017. All the patients treated with intensive hemodialysis for two months were included in the study. The Hb concentration was corrected by the subcutaneous injection of erythropoietin at the dose of 50-150 IU/kg three times per week. Results: Thirty-one ESRD patients with high pulmonary arterial pressure participated in this study. After the intervention, blood Hb levels increased significantly in the ESRD patients from 9.20±1.39 g/dL to 10.96±1.01 g/dL (P<0.0001). Pulmonary arterial pressure decreased significantly from 53.52±10.63 mmHg to 43.32±10.92 mm Hg (P<0.0001). Left ventricular ejection fraction increased significantly based on the visual assessment and Simpson’s method (2D echocardiography) from 41.06±10.76 to 43.00±11.28 and 46.26±13.72 to 48.36±13.90, respectively (P<0.0001). Absolute value of two dimensional global longitudinal strain (GLS) increased significantly from 13.99±5.05 to 15.14±5.32 (P<0.0001) after the intervention. Conclusion: Intensive hemodialysis for two months resulted in a significant increase in Hb concentrations, improved the LV systolic function and decreased pulmonary hypertension in ESRD patients. Trial registration: The trial protocol was approved in the Iranian Registry of Clinical Trials (identifier: IRCT20180212038705N1, https://www.irct.ir/trial/29593; Ethic code: IR.AJUMS. REC.1396.911).