Myocardial perfusion and left ventricular performance during long and short haemodialysis in patients with coronary heart disease.

In seven patients with confirmed coronary heart disease and stable blood pressure control acetate haemodialysis improved left ventricular performance and exercise tolerance. Similar positive effects were obtained by a four hour dialysis (one litre fluid removal/hour) and a two hour dialysis (two litre fluid removal/hour). In this group of patients weight gain and overhydration between dialyses appears to be the major risk for myocardial perfusion and rapid weight reduction by acetate dialysis appears adequate therapy. One practical consequence from our study is to minimise fluid overload in coronary heart disease and we try to avoid iatrogenic induction of thirst by decreasing dialysate sodium from 140 mmol/litre to 125-135 mmol/litre. As far as myocardial risk factors are concerned it appears that it is more important to focus on interdialysis weight gains than on acute dialysis therapy.