Acute Cardiovascular Changes Induced by Hemodialysis Assessed by Cardiac Magnetic Resonance

Background: Chronic kidney disease (CKD) is associated with a multifactorial cardiovascular burden, representing the leading cause of mortality in this population. In patients with CKD undergoing hemodialysis, interdialytic volume overload leads to increased cardiac volumes. Cardiac magnetic resonance (CMR) is the most accurate modality to quantify structural and functional cardiac changes, providing a detailed and reliable assessment of these alterations. This study aimed to identify acute cardiovascular changes induced by a single hemodialysis session in patients with CKD, evaluated by CMR.

Methods: We conducted a prospective, longitudinal, single-center study in 21 patients (mean age 41.6 ± 14.1 years) with CKD on chronic hemodialysis. CMR examinations were performed immediately before and 20 minutes after a hemodialysis session (mean ultrafiltration: 3.2 L). Biventricular functional parameters (end-systolic volume, end-diastolic volume, stroke volume, ejection fraction) and left atrial volume, as well as structural parameters (biventricular mass), were analyzed. Cardiac biomarkers (pro-BNP, troponin T, CK-MB) were also measured. Paired Student’s t-test was applied to compare pre- and post-dialysis measurements, with p < 0.05 considered statistically significant.

Results: Following hemodialysis, CMR demonstrated significant reductions in left ventricular end-systolic volume (54.7 vs. 43.0 mL; Δ –11.7; p = 0.0006), end-diastolic volume (95.5 vs. 78.8 mL; Δ –16.7; p = 0.0001), stroke volume (70.4 vs. 54.2 mL; Δ –16.2; p = 0.0136), and left atrial volume (48.1 vs. 40.7 mL; Δ –7.4; p = 0.0007). Clinically, systolic blood pressure decreased significantly (155.1 vs. 145.9 mmHg; Δ –9.3; p = 0.0476). Among cardiac biomarkers, pro-BNP levels showed a marked reduction (37,327 vs. 28,285 pg/mL; Δ –9,042; p < 0.0001), whereas troponin T and CK-MB remained unchanged.

Conclusion: A standard hemodialysis session induces acute reductions in left ventricular functional parameters, including end-systolic, end-diastolic, and stroke volumes, as well as left atrial volume, without significant changes in ventricular mass or left ventricular ejection fraction. Furthermore, a substantial post-dialysis decrease in pro-BNP was observed, while myocardial injury biomarkers remained stable.