The Pulsed Doppler Predictors of Intra Dialysis Hypotension and Relationship between Doppler Indices and Net Fluid Loss after Dialysis in Patients with End Stage Renal Disease: Pulsed Doppler Study

Background In patients with end stage renal disease (ESRD) on regular haemodialysis (HD), fluid status in the body has an important impact on the left ventricular (LV) filling and it can lead to intra-dialysis hypotension. The aim of the study is to study the pattern of diastolic pulsed Doppler filling in patients who had hypotension during HD and to correlate that with the net fluid loss at end of dialysis session. Material Fifty two patients with (ESRD) on regular HD, 34 male, with mean age of 45.5 ± 13 year were studied. Each patient had pulsed Doppler study before and immediately after HD. Each patient was observed for the development of acute clinical events and hypotension defined as systolic blood pressure of less than 90 mmHg. Patients were divided into two groups according to the amount of net ultra filtrate loss after HD, group I (n = 25) with fluid loss of <2 litres, and group II (n = 27) with ≥2 litres. Results The mean age was 45 ± 12 year for group I and 46 ± 11 year for group II. In the study group, 11 out of 52 (21%) patients developed systolic hypotension less than 90 mmHg during HD compared to those without, no patient necessitate HD discontinuation. The mean pre dialysis pulsed Doppler Early filling to late filling wave (E/A ratio) of those who developed hypotension was (0.7 ± 0.2 vs. 1.1 ± 0.2.1, p < 0.001) and the mean of Deceleration time of E wave (DT) (246 ± 40 vs. 224 ± 34 m.sec, p < 0.05) respectively. The mean difference between pre and post HD pulsed Doppler indices in group II compared with group I were as follow: the mean reduction of E wave velocity (32 ± 17 vs. 12 ± 15 m.sec, p < 0.01), the mean reduction of A wave velocity (13 ± 17 vs. 11 ± 16 m.sec, p = NS), E/A ratio reduced to 0.14 ± 0.03 vs. 0.01 ± 0.04, p < 0.05), the mean DT of E wave increase from (43 ± 51 vs. 16 ± 64 m.sec, p < 0.05). Conclusion In patient ESRD on regular hemodialysis, the prolonged DT >246 m.sec of E wave and E/A ratio less than 0.7 both may be used as a predictors of asymptomatic hypotension during HD. The net fluid loss during HD is directly proportional to the reduction of left ventricle Doppler diastolic indices.