Ejection fraction and dialysis

I have been on dialysis for almost 2 years – in center for 1 year and have been on home hemodialysis since April 13, 2015.

2 months ago, i was hospitalized for congestive heart failure and overload of fluid in my lungs. My cardiologist has recommended that a defibrillator be installed.

My question: Does dialysis improve my ejection fraction or is the defibrillator the only solution?

History: Ejection fraction is 20%. HHD – blood flow rate is 260, frequency - 4x a week, average weight gain between dialysis < 1k, had CHF and quadruple bypass in 2012.

Dear Trinidad

Thanks so much for your question. It is an important one.

I wrote a piece on the ejection fraction for this site some years ago … and if you haven’t read it, it might be useful for you to have a look at it . It is found at:

The reason your ejection fraction is down at a mere 20% is difficult to pin-point exactly from the information you have given me, but is likely a combination of cardiac damage from previous myocardial infarction(s) … the blockage of small coronary arteries - blood vessels - that lead to scarring and fibrosis … +/- additional over-stretching of your heart muscle from chronic fluid overload - something suggested by your history of admission(s) with fluid overload and left ventricular (congestive cardiac) failure … +/- any ongoing coronary artery perfusion problems suggested by your history of having needed a multiple bypass operation.

All this suggests your heart muscle has taken several ‘hits’ from several different quarters.

When the heart is poorly contracting, it is subject to sudden rhythm changes and disturbances as the electrical pathways that conduct the normal contractile wave (or cardiac impulse) through the heart muscle at every beat of the the heart is interrupted or altered.

I suspect the suggestion of an implantable defibrillator may be based on this and sounds a likely good suggestion.

At the same time, good dialysis and stringent volume control is essential too, if only to maximally control and minimize any over-stretching of the heart muscle. Some improvement may result in time if this can be achieved, but meantime, a defibrillator is a likely good move. Only your cardiologist can know this though … and I would certainly be taking his/her advice.

Thank you so much for the reply.

Your article on ejection fraction was very helpful.

Thank you so much for the reply.

Your article on ejection fraction was very helpful.