Impact of dialysis modality on the appropriateness of left ventricular mass in patients with end-stage renal disease

Background: Chronic dialysis treatment may increase systolic pulmonary pressure (SPAP) values. Although pulmonary hypertension (PHT) is a predictor of mortality in dialysis patients, right ventricular dysfunction (RVD) is a major cause of death. We investigated the impact of chronic dialysis on RV function. Methods: We examined 220 patients divided as follows: 1) healthy controls (C) (n=100) ; 2) peritoneal dialysis (PD) (n=26); HD with radial artero-venous fistula (AVF) (n=62); 3) HD with brachial AVF (n=32). All patients underwent echocardiography including Tissue Doppler Imaging (TDI) of the RV. Results: SPAP progressively rose from controls across the 3 dialysis groups (21.7±6.8, 29.7±6.7, 37.9±6.7, 40.8±6.6 mmHg, p<0.001). TDI indices of RV function were more impaired in HD patients, particularly in the presence of brachial AVF. RVD, assessed by TDI myocardial performance index (MPI), was higher in HD patients compared with PD (71.3% vs 34.6%, p<0.001). Moreover, the prevalence of RVD further increased in patients with brachial AVF compared with the radial access (90.6 vs 61.3%, p<0.001). Conclusions: Compared to DP, HD increases the risk of RVD, particularly in the presence of brachial AVF. TDI may early detect functional failure of the RV in HD patients.