Evaluation of cardiac function during hemodialysis in patients with chronic renal failure due to diabetic nephropathy

with special reference to systemic vascular resistance

Abstract

Aim: Cardiac function during hemodialysis (HD) was evaluated in 5 patients with chronic renal failure (CRF) due to diabetic nephropathy (DN group). The systemic vascular resistance of these patients was examined and compared with that of 10 patients with CRF due to non-diabetic nephropathy (non-DN group) and that of 5 patients with diabetes mellitus (DM) who has no renal dysfunction (DM·non-CRF group).
Subjects and methods: The 5 patients of the DN Group comprised 4 with maintenance HD and 1 with introduc-tion HD, aged between 59 and 67 years with a mean of 62 years. They had been suffering from DM for between 3 and 19 years with a mean period of 11 years. Two of the cases were IDDM and 3 were NIDDM. The method involved insertion of a Swan-Ganz cathether, and calculation of the cardiac index, the left ventricular stroke work index (SWI) and the systemic vascular resistance index (SVRI). Each of these determinations was evaluated before and every one hour after the start of HD and 30 minutes after the finish of the HD.
Conclusion: 1) The mean of the SVRI before the HD was (1.76±0.25)±10³dyn·sec·cm^-5·m², which was lower than the mean of normal cases, and tended to be lower than that of the non-DN group, and furthermore significantly (p<0.05) lower than those of the DM·non-CRF group. 2) Variations of SVRI and SWI during HD were also examined by comparing their respective values against pre-HD levels taken as 100%. The results revealed that the percentage SVRI showed on almost constant tendency regardless of variations in the percentage of SWI and showed a relationship of SVRI%=-0.104×(SWI%) +103.9 (r=-0.170, NS). This was significantly different from the SVRI%=-0.311×(SWI%) +132.5 (r=-0.421, p<0.05) obtained in the non-DN group.