Korean J Nephrol.  2008 May;27(3):333-340.

Intensive Hemodialysis in Patients with ESRD Improves Cardiac Function Through Inflammatory Regulation

• Boo CS
• Woo YS
• Lee JW
• Ko GJ
• Jo SK
• Cho WY
• Kim HK

Abstract

PURPOSE
CHF is a life threatening acute complication in ESRD populations. An intensive hemodialysis (HD) has been effective in reducing intravascular volume and in removing uremic toxin with improved systolic function. Although recent progress has identified an inflammation as an important contributor to the pathogenesis of CVD, the effect of intensive HD on inflammatory parameters and left ventricle (LV) systolic dysfunction is not clear. The purpose of this study is to examine the effect of intensive HD on LV systolic function and serum cytokines levels.
METHODS
Among ESRD patients who underwent dialysis and developed acute pulmonary edema due to LV systolic dysfunction were enrolled. Intensive HD consisted of daily 4 hours HD for 7 consecutive days. Data were prospectively collected and 2-D echocardiography was done before and after intensive HD. Serum levels of TNF-alpha and IL-10 were compared and lipopolysaccharide (LSP)-stimulated of these cytokines were measured.
RESULTS
After intensive HD, weight and mean arterial blood pressure decreased significantly and ejection fraction (EF) increased significantly. Serum IL-10 and TNF-alpha levels decreased significantly after intensive HD. In contrast, LPS stimulated production of these cytokines increased significantly after intensive HD. The difference of CRP between after HD and before HD was negatively correlated with the difference of EF.
CONCLUSION
In ESRD patients with acute LV dysfunction, intensive HD significantly improved EF and restored the immune responsiveness. These results suggest that intensive HD has the advantage of improving EF through modulating inflammation and correcting immune dysfunction in ESRD patients with acute LV dysfunction.

Keyword

Renal dialysis; Heart failure; Systolic; Ventricular ejection fraction; Inflammation; Cytokines

MeSH Terms

Arterial Pressure
Cytokines
Dialysis
Echocardiography
Heart Failure
Heart Ventricles
Humans
Imidazoles
Inflammation
Interleukin-10
Kidney Failure, Chronic
Nitro Compounds
Prospective Studies
Pulmonary Edema
Renal Dialysis
Stroke Volume
Tumor Necrosis Factor-alpha
Cytokines
Imidazoles
Interleukin-10
Nitro Compounds
Tumor Necrosis Factor-alpha