From the Patient's Perspective: How to Protect Your Heart?

Reprinted with permission from http://www.kamaldshah.com/2021/02/dialysis-protect-heart.html

The reason most dialysis patients lose their battle with kidney disease is not because of the kidneys but because of their hearts. Heart problems are the leading cause of mortality among dialysis patients.

Why is this the case?

When kidneys don't work well, they stop filtering out toxins and excess fluid from the blood. This causes a build-up of these toxins and fluid in the body. Excess fluid in the body causes the most impact on the heart.

The human heart can pump about five litres of blood. That is what it is capable of. Take a hemodialysis patient. Most hemodialysis patients put on anything between two to four litres of fluid weight between two dialysis sessions. If you are like me, then that could be even higher.

That means the heart has to pump between 40 to 80% more than the fluid it is used to pumping. This excess fluid is then removed at a very rapid rate during the dialysis session. This results in myocardial stunning where the heart is suddenly deprived of blood.

All this cannot happen with no side effects, right? The heart grows in size and many patients have enlarged hearts in a few years of dialysis. After a few years, the capacity of the heart to function deteriorates and at one point, it just fails.

There are several other factors that contribute to poor heart health on dialysis like poor removal of toxins, mineral and bone disorders, etc. But the most important cause is fluid overload.

What can we do to protect our heart?

The most obvious thing that we can do is to reduce the excess fluid in the body. Either drink less or do more frequent dialysis. If you can't drink less, the only solution is more dialysis. The key is to not allow too much fluid to build up in the body so that the heart has to pump less. 

The other thing is to remove fluid at a more gentle rate. This means increasing the hours of dialysis. If you are going to remove fluid rapidly, this results in myocardial stunning. The safe fluid removal rate is 10 ml/kg/hour. So if you are doing a four-hour session and weigh 70 kg, remove only up to 2.8 litres. Anything more than that and you are inviting trouble. So, what to do if you have put on 4 kg? Increase the duration of your dialysis session to about 6 hours.

Peritoneal Dialysis is a fantastic modality that takes care of all these problems inherently.

A 2D Echocardiogram done annually will tell you the status of your heart. One important thing to look for in this report is the Ejection Fraction. If this value is above 55, it is good. 

For those on hemodialysis, please remember that the most important factor to protect your heart is Fluid. The key is to never let too much excess fluid remain in your body and when you are removing it, remove it gently.