Outcomes of Intermittent Infusion Hemodiafiltration in Patients with Cardiac Hypofunction on Maintenance Hemodialysis

Abstract

Background: Following the onset of heart failure symptoms, fluid removal is usually intensified, but patients with decreased cardiac function may develop sudden hypotension due to poor plasma refilling and functional impairment of the mechanisms that maintain blood pressure. In these patients, removal of fluids then becomes difficult. Impairment of the mechanisms that maintain blood pressure can be treated with vasopressors, but intermittent infusion hemodiafiltration (I-HDF) may be effective for managing poor plasma refilling. Thus, here I-HDF was performed in patients with cardiac hypofunction who were undergoing maintenance hemodialysis (HD) in order to assess the clinical effects. Summary: Participants were 5 patients with cardiac hypofunction on maintenance HD. HD and I-HDF were performed for a total of 6 months each. A comparison was made of changes in dry weight (DW) and cardiothoracic ratio (CTR), blood test results, echocardiography findings, plasma-refilling rate (PRR), and tissue blood flow. During I-HDF, a decrease in DW was achieved and CTR was significantly improved. Echocardiographic findings showed that left ventricular diameter improved significantly during I-HDF. Higher PRR values and increased tissue blood flow were-observed during I-HDF compared with HD. Intermittent infusions during I-HDF prevented organ ischemia and suppressed the De Jager-Krogh phenomenon. This may be associated with the promotion of stable plasma refilling. Key Messages: Excessive fluid retention is a cause of heart failure symptoms. I-HDF facilitates removal of excessive fluid and thereby possibly contributes to the improvement of cardiac function.