**7. Cardiac effects of haemodynamic stability**

Cardiac failure and the rate of cardiovascular mortality are extremely high in dialysis patients. One of the major causes of heart failure in these patients is probably recurrent subclinical myocardial ischemia. Selby et al. examined whether this occurs in response to stress of haemodialysis and whether it can be reduced by improved hemodynamic stability with HBS treatment (Selby et al., 2006). Eight hypotension-prone patients were included in a randomised cross-over trial to compare the development of left-ventricular regional-wall motion abnormalities during HBS treatment and standard HD. There were 42 regional-wall motion abnormalities during HD vs 23 during HBS (odds ratio 1.8; 95% CI: 1.1 to 3.0). The majority of these abnormalities improved in function within 30 minutes after dialysis (Figure 7). At peak stress, ejection fraction was significantly lower during HD (*P*=0.043). Haemodynamic parameters, such as pulse rate, stroke-volume decrease, cardiac output decrease, peripheral resistance and mean baroflex sensitivity, were all significantly improved during HBS vs HD. We noted comparable results in a retrospective analysis of 18 patients after 48 weeks of HBS treatment (Winkler et al., 2008): ejection-fraction increase, though not significant, and a decrease in left ventricular-mass index (*P*<0.05). In addition, the use of antihypertensive drugs decreased (Figure 7). Two other groups looked at the effect of HBS treatment on antihypertensive drug use (Dasselaar et al. 2007, Neshrallah et al., 2008). Dasselaar et al. showed that the defined daily dose (DDD) of antihypertensive drugs decreased (not significantly) in the HBS group, whereas it was stable in the control HD arm (Dasselaar et al., 2007). Nesrallah et al. observed no change in antihypertensive drug use in their randomised controlled trial (Neshrallah et al., 2008).

Fig. 6. Analysis of left ventricular wall motion in one patients during conventional (HD) and biofeedback dialysis (BFD). Arrows indicates the regional wall motion abnormalities which persist even after the end of the treatment (Selby et al., 2006).

Cardiac failure and the rate of cardiovascular mortality are extremely high in dialysis patients. One of the major causes of heart failure in these patients is probably recurrent subclinical myocardial ischemia. Selby et al. examined whether this occurs in response to stress of haemodialysis and whether it can be reduced by improved hemodynamic stability with HBS treatment (Selby et al., 2006). Eight hypotension-prone patients were included in a randomised cross-over trial to compare the development of left-ventricular regional-wall motion abnormalities during HBS treatment and standard HD. There were 42 regional-wall motion abnormalities during HD vs 23 during HBS (odds ratio 1.8; 95% CI: 1.1 to 3.0). The majority of these abnormalities improved in function within 30 minutes after dialysis (Figure 7). At peak stress, ejection fraction was significantly lower during HD (*P*=0.043). Haemodynamic parameters, such as pulse rate, stroke-volume decrease, cardiac output decrease, peripheral resistance and mean baroflex sensitivity, were all significantly improved during HBS vs HD. We noted comparable results in a retrospective analysis of 18 patients after 48 weeks of HBS treatment (Winkler et al., 2008): ejection-fraction increase, though not significant, and a decrease in left ventricular-mass index (*P*<0.05). In addition, the use of antihypertensive drugs decreased (Figure 7). Two other groups looked at the effect of HBS treatment on antihypertensive drug use (Dasselaar et al. 2007, Neshrallah et al., 2008). Dasselaar et al. showed that the defined daily dose (DDD) of antihypertensive drugs decreased (not significantly) in the HBS group, whereas it was stable in the control HD arm (Dasselaar et al., 2007). Nesrallah et al. observed no change in antihypertensive

**7. Cardiac effects of haemodynamic stability** 

drug use in their randomised controlled trial (Neshrallah et al., 2008).

Fig. 6. Analysis of left ventricular wall motion in one patients during conventional (HD) and biofeedback dialysis (BFD). Arrows indicates the regional wall motion abnormalities which

persist even after the end of the treatment (Selby et al., 2006).
