ABSTRACTS from 16th International COnference on ... - CRRT Online

Myocardial Stunning and Brain Edema: Acute Effects of Dialysis
Educational Objectives:
1. Understand how the circulatory stress of dialysis can affect tissue perfusion
2. Discuss the impact of dialysis induced hypoperfusion on the heart and brain
3. Review possible interventions to ameliorate these processes
Nick Selby MD
4:00-4:15
Thursday, February 16
Content Description:
Dialysis patients are subject to hugely elevated rates of cardiovascular mortality. The haemodynamic perturbation
of haemodialysis, in particular intradialytic hypotension, may contribute to adverse clinical outcomes through
hypoperfusion of critical vascular beds. Dialysis patients are particularly susceptible to such injury due to a variety
of processes that include reductions in coronary flow reserve. The evidence that dialysis can lead to subclinical
ischaemic insults to the myocardium will be reviewed. Important clinical determinants of this process will be
elucidated in addition to examining the longer term effects of repetitive dialysis-induced ischaemic injury.
Potential therapeutic interventions in terms of the delivery of dialysis will also be discussed. How these processes
may also impact on other target organs, in particular the brain will also be reviewed.
Suggested Reading:
McIntyre CW. Effects of hemodialysis on cardiac function. Kidney Int. 2009 Aug;76(4):371-5.
McIntyre CW, Burton JO, Selby NM, Leccisotti L, Korsheed S, Baker CS, Camici PG. Hemodialysis-induced
cardiac dysfunction is associated with an acute reduction in global and segmental myocardial blood flow. Clin J
Am Soc Nephrol. 2008 Jan;3(1):19-26.
Selby NM, Burton JO, Chesterton LJ, McIntyre CW. Dialysis-induced regional left ventricular dysfunction is
ameliorated by cooling the dialysate. Clin J Am Soc Nephrol. 2006 Nov;1(6):1216-25. Epub 2006 Oct 11.
Selby NM, McIntyre CW. The acute cardiac effects of dialysis. Semin Dial. 2007 May-Jun;20(3):220-8.
Selby NM, Lambie SH, Camici PG, Baker CS, McIntyre CW. Occurrence of regional left ventricular dysfunction
in patients undergoing standard and biofeedback dialysis. Am J Kidney Dis. 2006 May;47(5):830-41.
Burton JO, Jefferies HJ, Selby NM, McIntyre CW. Hemodialysis-induced repetitive myocardial injury results in
global and segmental reduction in systolic cardiac function. Clin J Am Soc Nephrol. 2009 Dec;4(12):1925-31.
Burton JO, Jefferies HJ, Selby NM, McIntyre CW. Hemodialysis-induced cardiac injury: determinants and associated
outcomes. Clin J Am Soc Nephrol. 2009 May;4(5):914-20. Epub 2009 Apr 8.
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