Myocardial Stunning During Hemodialysis: Role of Dialyste Calcium Concentration
Condition: Myocardial Stunning; End-stage Renal Disease
MeSH terms: Kidney Failure, Chronic; Myocardial Stunning
Study type: Interventional

Summary: 
      Chronic kidney disease (CKD) is linked to elevated mortality rate, and cardiovascular disease
      is the main cause related to this outcome. The cardiovascular mortality among patients on
      conventional hemodialysis (CHD) is high, achieving up to 30 times more risk of death when
      comparing to individuals of same age on general population. Congestive heart failure can
      develop in 25% to 50% of patients, leading to a worse prognosis. CKD patients present
      anatomic and functional abnormalities on peripheral bed vases and also cardiovascular
      abnormalities that can cause myocardial ischemia. This last usually is transitory and lead to
      left ventricular dysfunction that can persist even after the end of dialysis session despite
      normal coronary perfusion. The prolonged dysfunction is called myocardial stunning (MS).
      Patients on CHD are subject to hemodynamic instability, myocardial ischemia and development
      of regional abnormalities of myocardial wall (ARPM´s). MS induced by intradialytic ischemia
      is a complication that can be minimized by applying techniques associated to more stability
      during the CHD, as cool dialysate or increasing the length of the therapy. The goal of the
      present study is to evaluate the behavior of cardiovascular system (trough hemodynamic
      performance during CHD, accessing MS by echocardiography technique, and biomarkers associated
      to MS). Finally, the investigators aimed to investigate the role of two different dialysate
      calcium concentration (2,5 and 3,5 mEq/l) in the genesis of MS during CHD. The elucidation of
      pathogenesis of MS during CHD might help us modified hemodialysis technique in order to
      prevent MS, and reduce the high cardiovascular mortality among CKD patients.
    

Detailed description: 
      Patients on hemodialysis patients present anatomic and functional abnormalities on peripheral
      bed vases and also cardiovascular abnormalities that can cause myocardial ischemia. This last
      usually is transitory and lead to left ventricular dysfunction that can persist even after
      the end of dialysis session despite normal coronary perfusion. The prolonged dysfunction is
      called myocardial stunning (MS). Patients on dialysis are subject to hemodynamic instability,
      myocardial ischemia and development of regional abnormalities of myocardial wall (ARPM´s).
      Some authors have demonstrated that CHD cause segmental and global myocardial ischemia, and
      up to 65% of patients have recurrent myocardial ischemia. There are some associated factors:
      high ultrafiltration rates, intradialytic hypotension, reduced systolic blood pressure and
      high risk of cardiovascular events and death. MS induced by intradialytic ischemia is a
      complication that can be minimized by applying techniques associated to more stability during
      the CHD, as cool dialysate or increasing the length of the therapy. More specifically, MS can
      be the result of repair process, with oxygen free radicals generation and reduction of the
      synthesis of contractile proteins, in association with a reduced muscle responses to calcium
      which in turns lead to ventricular dysfunction (the calcium hypothesis). The goal of the
      present study is to evaluate the behavior of cardiovascular system (trough hemodynamic
      performance during CHD, accessing MS by echocardiography technique, and biomarkers associated
      to MS). Finally, the investigators aimed to investigate the role of two different dialysate
      calcium concentration (2,5 and 3,5 mEq/l) in the genesis of MS during CHD. The elucidation of
      pathogenesis of MS during CHD might help us modified hemodialysis technique in order to
      prevent MS, and reduce the high cardiovascular mortality among CKD patients.
    

Intervention name(s): Change the dialysate calcium concentration
Intervention type(s): Other
Intervention description(s): The dialysate calcium concentration will be changed according to the prior concentration
Intervention MeSH terms: Dialysis Solutions; Calcium
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: myocardial stunning; dialysate calcium concentration; nutritional status; hemodinamic; hemodialysis