STUDIO A LUNGO TERMINE DELLA FUNZIONE MIOCARDICA IN BIOFILTRAZIONE SENZA ACETATO (AFB)

In order to verify long term effects of acetate-free biofiltration (AFB) on cardiac function, we studied 5 RDT patients previously treated with bicarbonate hemodialysis and then shifted to AFB. Follow-up lasted 83 months. Doppler echocardiography and multi gated cardioscintigraphy were used to examine left ventricular parameters. Diastolic function, evaluated with diastolic filling, end diastolic filling, atrial contraction and their ratio E/A, was unchanged. On the other hand, there was a significant reduction on AFB in fractional shortening and ejection fraction with increased end diastolic and systolic diameters. However, intraventricular septum thickness was unchanged. Biochemical parameters and treatment efficacy (KT/V) were comparable; in AFB there was a better correction of uremic acidosis in spite of a reduction of treatment time of about 25%. Patients showed a tendency towards an increase of interdialytic weight gain and of clinically estimated dry weight, and a reduction of intradialytic hypotension. AFB, even at long term, do not impair left ventricular compliance and do not cause cardiac hypertrophy; however, it is necessary to be cautious in reducing treatment time to avoid increased preload and systolic dysfunction.