Abstract 13932: Association of Heparin Exposure With 5-year Mortality and Heart Failure in Patients With End-Stage Kidney Disease on Hemodialysis

Abstract

Introduction: Fibroblast growth factor (FGF) 23 is strongly upregulated in end-stage renal disease (ESRD) on dialysis and induces left ventricular hypertrophy (LVH) through activation of cardiac FGF receptor 4. Recent experimental animal data suggest that heparin acts as a co-receptor for FGF23, promoting binding to cardiac cells and LVH. Hypothesis We hypothesized that mortality and HF risk would be higher among patients with ESRD on hemodialysis who are regularly exposed to heparin during dialysis sessions. Methods: Using data from the TriNetX Research Network, we identified patients with ESRD (ICD-10 code N18.6) who received dialysis services (Z49.X) or were dependent on dialysis (Z99.2), for ≥5 instances 1 month apart, during years 2011-2017. Patients were stratified by heparin exposure during dialysis (≥5 instances vs. no exposure). Patients on peritoneal dialysis were excluded. We examined 5-year mortality and HF risk, after matching for demographics, background conditions, laboratory values, and vital signs at baseline. We used Kaplan-Meier estimates for incidence and Cox proportional hazards models for hazard ratios. Results: We matched 2131 patients who were exposed to heparin (≥5 instances) during dialysis and 2131 who were not. The two cohorts were balanced for characteristics, as evident from standardize mean differences <0.1, Table 1. Kaplan-Meier mortality at 5 years was 44.4% in the heparin-exposed cohort vs. 31.4% in the non-exposed cohort (HR 1.39, 95%CI 1.24-1.55; P<0.001). Incidence of HF at 5 years was also higher with heparin exposure: 44.3% vs. 34.0% in the non-exposed cohort (HR 1.35, 95% CI 1.17-1.5; P<0.001). Conclusion In this comparative retrospective study of propensity score matched patients with ESRD on dialysis, regular exposure to heparin was associated with higher mortality and HF risk at 5 years. Despite the shortcomings of a retrospective study, these hypothesis-generating findings merit investigation in prospective studies.