#6869 CARDIAC ALTERATIONS FOUND IN PATIENTS WHO START DIALYSIS

Abstract

Abstract Background and Aims The presence of cardiac structural alterations in patients with chronic kidney disease who start renal replacement therapy is frequent. In fact, the real prevalence of heart failure is not well known due to the masking of symptoms by frequent ultrafiltration. Despite this, most deaths in these patients occur due to cardiovascular events, especially non-atheroembolic events, which are closely related to heart failure and ventricular remodeling. This study aimed to describe the echocardiographic alterations present in patients who start renal replacement therapy. Method Cross-sectional study to evaluate the prevalence of structural abnormalities in transthoracic echocardiography performed in patients at the time of initiating renal replacement therapy in the prevalent group of patients in kidney replacement therapy program at Hospital Clínic de Barcelona. Demographic variables and baseline drugs for heart failure were also collected. Results We included 170 patients of 67.84 ± 15.92 years. 115 (67.6%) were men, and 55 were women (32.4%). Of these, 124 (72.9%) were on hemodialysis, 11 (6.5%) on home hemodialysis, and 35 (20.6%) on peritoneal dialysis. Transthoracic echocardiogram findings at the beginning of dialysis showed a left ventricular ejection fraction of 47.5 ± 10.6%. It was reduced in 21 (12.4%), slightly reduced in 9 (5.3%) and preserved in 125 (73.5%) of the patients. The estimated pulmonary artery systolic pressure was 28.5 ± 3.53 mmHg. The telediastolic diameter of the left ventricle was 5.5 ± 0.71 cm, that of the interventricular septum was 1.15 ± 0.27 cm, the diameter of the left atrium was 4.5 ± 1.27 cm, its volume was 95.05 ± 56.5 mL in the biplane section and 54.3 ± 28.28 mL in the four-chamber section. There were no significant differences between groups when analyzed by type of renal replacement therapy. Regarding valvulopathies, 47 (21.8%) had some degree of aortic stenosis, 68 (40%) had some degree of aortic insufficiency, 104 (62.2%) had some degree of tricuspid insufficiency, 118 (69.4%) some degree of mitral insufficiency. Regarding treatment, 50 (29.4%) of the patients had some RAASi, 60 (35.3%) had beta-blockers, and 2 (1.2%) had MRA. Conclusion The presence of structural alterations in the heart of patients initiating renal replacement therapy is practically universal and independent of the type of technique initiated. Nephrologists should become aware of these findings and seek ways to prevent and reverse these alterations as far as possible to achieve better clinical results in dialysis.