الفهرس 
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Abstract
Cardiovascular disease is the leading cause of mortality in patients receiving haemodialysis (HD). Among these patients, serious arrhythmias and sudden cardiac arrests, rather than acute myocardial infarction or stroke, are the most frequent causes of cardiovascular death.
Most patients on maintenance HD follow the typical schedule of three sessions per week, and thus remain outside dialysis for two short intervals (~ 2 days in duration) and for a longer interval (~3 days) at the end of each week.
Despite recent improvement in dialysis process, patients receiving maintenance dialysis still have high hospitalization rates, poor quality of life, and high mortality
Although this link between the long interval and worsened cardiovascular outcomes has attracted increasing attention, few studies have examined the underlying mechanisms. The exact pathophysiologic mechanisms underlying changes in cardiac function and sizing during intradialytic intervals are also obscure. Several factors could be involved, such as volume overload, acid-base, and electrolyte shifts, as well as arterial and myocardial wall changes.
Only a handful of studies have examined cardiac function changes during intradialytic intervals and just one compared changes in echocardiographic indices of left and right ventricle during the 3-day and the 2-day intradialytic
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interval. So we aimed to do comparison of Echocardiographic parameters during long and short interdialytic intervals in haemodialysis patients.
Echocardiography is a radiation-free, noninvasive, and widely available imaging technique for the diagnosis and management of patients with suspected or known heart diseases. This technique has been extensively applied to study heart morphology and function in patients receiving HD in resting conditions or during HD treatments.
Our study conducted on 30 clinically stable Prevalent ESRD patients on regular HD with frequency of 3 times per week and Arteriovenous fistula as a vascular access. Patients were collected from The Misr University For Since and Technology by exclusion of patients with temporary or permanent catheter as vascular access, unstable and debilited patients, malignancy and uncontrolled hypertension. The current study were enrolled from September 2019 till February 2020. patients ages ranged between 28 and 75 years old with mean age of 56.23±12.31 years (43.4% of them were females and 56.7% were males)
The 30 studied patients were compared as two groups:
group 1 comprised the 30 HD patients who were studied before and after the 2- day (short) interdialytic interval.
group 2 comprised the same 30 HD patients who were studied before and after the 3-day (long) interdialytic interval.
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In all patients, we recorded full history and clinical examination with emphasis on Demographic data etiology of renal failure and associated complications. We also recorded full lab results for every patient, four echocardiograph were done for every patient to Assess cardiovascular parameters in the study group before and after The Hemodialysis sessions regarding the long and short interdialytic intervals.
Results of this study demonstrated that results of comparison of echocardiographic measurements before dialysis between the short (2-days) and long (3-day) interdialytic interval groups (group 1 Vs group 2). There were no statistically significant differences between left ventricular (LV) systolic and diastolic dimensions, septum affection, ejection fraction, or pulmonary artery pressure.
On the other hand, there were statistically highly significant differences between left PCWP and IVC diameter prior to dialysis session between the short and the long interdialytic interval patients’ groups.
The results of comparison of echocardiographic measurements after dialysis between the short (2-days) and long (3-day) interdialytic interval patients’ groups (group 1 Vs group 2). Revealed there were no statistically significant differences between LV systolic and diastolic dimensions, septum affection, ejection fraction, or pulmonary artery pressure.
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On the other hand, there were statistically highly significant differences among PCWP, IVC and interdialytic weight change after dialysis session between the short and the long interdialytic interval patients’ groups
from the above results, it is apparent that there are elevations in IVC, PCWP and intradialytic weight gain between both short and long interdialytic interval. However, the intradialytic weight gain (2.45 ± 1.13 vs 1.19 ± 0.78 kg), inferior vena cava diameter (11 ± 2.98 vs 9.62 ± 2.32) and PCWP (11.13 ± 2.3 vs 10.13 ± 1.55) increase were higher during the 3-day versus the 2-day interval (P < 0.001). LV end systolic diameter, LV end diastolic diameter, septum, ejection fraction and pulmonary artery pressure indexes showed generally no differences between interdialytic intervals group comparison.
To summarize, the comparisons of this study consistently showed that there are highly significant differences regarding IVC diameter and PCWP between short and long interdialytic intervals. In addition, intradialytic weight increase was higher during the 3-day versus the 2-day interval in post dialysis comparison
Overall, the above data, along with the evidence of increased morbidity and mortality toward the end of the long interval, call for detailed heart imaging studies to examine whether these intradialytic and interdialytic alterations translate into long term consequences in cardiac function and whether
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they mediate the day-of-week mortality pattern in conventional dialysis.
Most cardiovascular diseases can be minimised by addressing behavioural risk factors such as volume overload which can be monitored through patient education, assessing the optimal dry weight, regular follow up by ECHO, also it will be more valuable to consider establishing HD day after day instead of long intradialytic period especially for high risk cardiac patients.