TY - JOUR
T1 - Association of segmental wall motion abnormalities occurring during hemodialysis with post-dialysis fatigue
AU - Dubin, Ruth F.
AU - Teerlink, John R.
AU - Schiller, Nelson B.
AU - Alokozai, Dean
AU - Peralta, Carmen A.
AU - Johansen, Kirsten L.
N1 - Funding Information:
Funding for this project came from the following sources. (i) Individual Investigator Grant, University of California San Francisco Academic Senate, San Francisco, CA, USA. (ii) Grant Huntington Fund provided by the Research Evaluation and Allocation Committee in the University of California San Francisco, School of Medicine Dean’s Office, San Francisco, CA, USA. (iii) National Institute of Diabetes and Digestive and Kidney Diseases, 1K24-DK085153-02. (iv) National Institute of Diabetes and Digestive and Kidney Diseases, 1K23-DK092354-01A1. (v) UCSF Clinical and Translational Science Institute grant number UL1 TR000004.
PY - 2013/10
Y1 - 2013/10
N2 - BackgroundPost-dialysis fatigue (PDF) is a common, debilitating symptom that remains poorly understood. Cardiac wall motion abnormalities (WMAs) may worsen during dialysis, but it is unknown whether WMA are associated with PDF.MethodsForty patients were recruited from University of California San Francisco-affiliated dialysis units between January 2010 and February 2011. Participants underwent echocardiograms before and during the last hour of 79 dialysis sessions. Myocardial segments were graded 1-4 by a blinded reviewer, with four representing the worst WMA, and the segmental scores were summed for each echocardiogram. Patients completed questionnaires about their symptoms. Severe PDF (defined as lasting >2 h after dialysis) was analysed using a generalized linear model with candidate predictors including anemia, intradialytic hemodynamics and cardiac function.ResultsForty-four percent of patients with worsened WMA (n=9) had severe PDF, compared with 13% of patients with improved or unchanged WMA (P = 0.04). A one-point increase in the WMA score during dialysis was associated with a 10% higher RR of severe PDF [RR: 1.1, 95% CI (1.1, 1.2), P < 0.001]. After multivariable adjustment, every point increase in the WMA score was associated with a 2-fold higher risk of severe PDF [RR: 1.9, 95% CI (1.4, 2.6), P < 0.001]. History of depression was associated with severe PDF after adjustment for demographics and comorbidities [RR: 3.4, 95% CI (1.3, 9), P = 0.01], but anemia, hemodynamics and other parameters of cardiac function were not.ConclusionsAlthough cross-sectional, these results suggest that some patients may experience severe PDF as a symptom of cardiac ischemia occurring during dialysis.
AB - BackgroundPost-dialysis fatigue (PDF) is a common, debilitating symptom that remains poorly understood. Cardiac wall motion abnormalities (WMAs) may worsen during dialysis, but it is unknown whether WMA are associated with PDF.MethodsForty patients were recruited from University of California San Francisco-affiliated dialysis units between January 2010 and February 2011. Participants underwent echocardiograms before and during the last hour of 79 dialysis sessions. Myocardial segments were graded 1-4 by a blinded reviewer, with four representing the worst WMA, and the segmental scores were summed for each echocardiogram. Patients completed questionnaires about their symptoms. Severe PDF (defined as lasting >2 h after dialysis) was analysed using a generalized linear model with candidate predictors including anemia, intradialytic hemodynamics and cardiac function.ResultsForty-four percent of patients with worsened WMA (n=9) had severe PDF, compared with 13% of patients with improved or unchanged WMA (P = 0.04). A one-point increase in the WMA score during dialysis was associated with a 10% higher RR of severe PDF [RR: 1.1, 95% CI (1.1, 1.2), P < 0.001]. After multivariable adjustment, every point increase in the WMA score was associated with a 2-fold higher risk of severe PDF [RR: 1.9, 95% CI (1.4, 2.6), P < 0.001]. History of depression was associated with severe PDF after adjustment for demographics and comorbidities [RR: 3.4, 95% CI (1.3, 9), P = 0.01], but anemia, hemodynamics and other parameters of cardiac function were not.ConclusionsAlthough cross-sectional, these results suggest that some patients may experience severe PDF as a symptom of cardiac ischemia occurring during dialysis.
KW - end-stage renal disease
KW - hemodialysis
KW - post-dialysis fatigue
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U2 - 10.1093/ndt/gft097
DO - 10.1093/ndt/gft097
M3 - Article
C2 - 23743019
AN - SCOPUS:84884947560
SN - 0931-0509
VL - 28
SP - 2580
EP - 2585
JO - Nephrology Dialysis Transplantation
JF - Nephrology Dialysis Transplantation
IS - 10
ER -