Cool temperature dialysis (CTD) has been shown to sharply decrease the frequency of intradialytic hemodialysis hypotension, but the mechanism of this hemodynamic protection is unknown. Therefore, we performed two-dimensional echocardiographic studies of left ventricular contractility in six stable hemodialysis patients before and after hemodialysis at 37°C (RTD) and 35°C (CTD). Left ventricular function was assessed by plotting the rate-corrected velocity of circumferential fiber shortening (Vcf(c)) against end-systolic wall stress (σ(es)) at four different levels of afterload. Linear regression was used to calculate Vcf(c) at a common afterload of 50 g/cm2. Changes in weight and dialysis parameters were similar following RTD and CTD. Mean arterial pressure and heart rate did not change significantly following RTD or CTD. The Vcf(c)-σ(es) relation was shifted upward in each patient after CTD, indicating increased contractility as compared to RTD or pre-dialysis baseline. Pre-dialysis Vcf(c) at an afterload of 50 g/cm2 was similar during RTD and CTD (0.94 ± 0.24 circ/sec vs. 0.92 ± 0.22 circ/sec). Postdialysis Vcf(c) at an afterload of 50 g/cm2 was significantly higher for CTD than for RTD (1.13 ± 0.29 circ/sec vs. 0.98 ± 0.30 circ/sec, P = 0.0004). Thus, cool temperature dialysis increases left ventricular contractility in hemodialysis patients, which may be a potential mechanism whereby hemodynamic tolerance to the dialysis procedure is improved.
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