Heart Discomfort During Dialysis: Causes and Solutions

Discomfort in the heart during dialysis?

Dear Dr.
Wu,
I have a family member, a 30-year-old female, who has been undergoing dialysis treatment for nearly two years.
Recently, she experienced a sudden myocardial infarction and underwent cardiac catheterization and coronary artery bypass grafting, which was relatively successful.
Post-surgery, she continues to attend the clinic for dialysis three times a week.
However, she has recently reported occasional chest pain and discomfort during dialysis, prompting the nurses to terminate the treatment early.
After the needles are removed, her chest discomfort alleviates and eventually disappears.

The clinic physician performed an electrocardiogram and mentioned that one of her blood vessels is experiencing ischemia (which I do not fully understand).
Her hemoglobin levels have been measured at approximately 21-25, which is somewhat low.
During her next dialysis session, she will receive a blood transfusion to increase her hemoglobin levels.
Interestingly, after the transfusion, she did not experience any chest pain or discomfort during dialysis.
I am unsure if her symptoms are genuinely related to low hemoglobin levels or if they are due to issues with the heart's blood vessels.
Additionally, should we consider reducing the blood flow rate during dialysis? I would greatly appreciate your insights on this matter.
Thank you.

Mai Zi, 30~39 year old female. Ask Date: 2021/07/12

Dr. Wu Jiyu reply Internal Medicine

Based on your inquiry, the hemoglobin measurement is approximately 21-25, which is low.
After blood transfusion, you may discuss with your physician whether erythropoietin (EPO) or iron supplements are adequate or if there are other bleeding issues (such as gastrointestinal bleeding) to improve the anemia situation and stabilize the pre-existing cardiovascular disease.
Regarding reducing the blood flow rate during dialysis, this may alleviate discomfort between sessions, but in the long term, it is important to consider whether the dialysis is insufficient.
Please discuss this with your physician.
Thank you for your inquiry; the Nephrology Department at Changhua Hospital is concerned about your health.

Reply Date: 2021/07/12

More Info

Understanding heart discomfort during dialysis is crucial, especially for patients with a history of cardiovascular issues. In your case, your family member, a 30-year-old woman undergoing dialysis, has experienced heart pain and discomfort during treatment, particularly after a recent myocardial infarction and subsequent coronary artery bypass surgery. This situation raises several important considerations regarding the relationship between dialysis, blood oxygen levels, and heart health.

Firstly, it is essential to understand that patients undergoing dialysis often have compromised kidney function, which can lead to anemia due to reduced erythropoietin production. Erythropoietin is a hormone produced by the kidneys that stimulates the production of red blood cells. Low hemoglobin levels, as indicated by the hemoglobin measurements of 21-25, can lead to decreased oxygen-carrying capacity of the blood. This condition can result in symptoms such as fatigue, weakness, and, in some cases, cardiovascular discomfort, particularly during physically demanding situations like dialysis.

The heart requires a constant supply of oxygen-rich blood to function effectively. During dialysis, the process can sometimes lead to fluctuations in blood volume and pressure, which may exacerbate any existing ischemic conditions, especially in patients with a history of heart disease. If a blood vessel is already compromised or "hypoxic," as your doctor indicated, the additional stress of dialysis can lead to angina-like symptoms or discomfort. This is particularly true if the blood flow is not adequate to meet the heart's demands during the dialysis process.

The fact that your family member experiences relief from heart discomfort after the dialysis needles are removed suggests that the discomfort may be related to the dialysis process itself rather than a direct cardiac event. It is possible that the blood flow rate during dialysis may need to be adjusted. High blood flow rates can sometimes lead to hemodynamic instability, which could contribute to feelings of discomfort or pain. Therefore, discussing the possibility of lowering the blood flow rate with the healthcare team may be beneficial.

Additionally, the improvement in symptoms following a blood transfusion indicates that the low hemoglobin levels were likely contributing to the heart discomfort. By increasing the hemoglobin concentration, the transfusion enhances the blood's oxygen-carrying capacity, which can alleviate the strain on the heart during dialysis. This highlights the importance of monitoring hemoglobin levels regularly and addressing anemia promptly in dialysis patients.

In conclusion, the heart discomfort experienced during dialysis could be multifactorial, involving low hemoglobin levels, the hemodynamic changes associated with dialysis, and the underlying cardiovascular condition. It is crucial to maintain close communication with the healthcare team, including nephrologists and cardiologists, to ensure that the dialysis regimen is optimized for your family member's specific needs. Regular monitoring of hemoglobin levels, adjusting dialysis parameters, and possibly further cardiovascular evaluation may be necessary to prevent future episodes of discomfort and ensure overall well-being during treatment.

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