MO1009TWENTY-FOUR-HOUR AUGMENTATION AND CARDIAC INDEX LEVELS ARE INCREASED IN CHILDREN ON HEMODIALYSIS COMPARED TO PERITONEAL DIALYSIS PATIENTS

Abstract

Abstract Background and Aims Cardiovascular disease is highly prevalent in the chronic kidney disease population and associates with higher morbidity and mortality even in young ages. The aim of the present study was to assess data from 24h ambulatory blood pressure monitoring (ABPM) and 24h pulse wave analysis (PWA) in dialyzed children and investigate their association with left ventricular mass as a marker of increased cardiovascular risk. Method Children and adolescents aged 6 to 18 years, on dialysis for more than 12 months, [16 on peritoneal dialysis (PD) and 12 on hemodialysis (HD)], underwent 24h ABPM, 24h PWA, and echocardiography. Results Peripheral and central blood pressures (BPs), mean pulse wave velocity (PWV) and left ventricular mass index (LVMI) were similar between PD and HD patients (figure 1a,b). Among PWA hemodynamic parameters, augmentation index (AIx75), cardiac index (CI), and heart rate were higher in the HD group (p<0.05) (figure 1c,d). LVMI was associated with hemoglobin (Hb) (R2=0.19, p<0.05)mean arterial pressure (MAP) (R2=0.34, p<0.005), central systolic BP (cSBP) (R2=0.39, p<0.001), AIx75 (R2=0.26, p<0.005), CI (R2=0.14 p<0.05) and PWV (R2=0.26, p<0.005), but not with weight, body mass index or relative overhydration. CI and AIx75 were higher in the HD group compared to PD both in patients with normal LVMI and those with left ventricular hypertrophy (LVH). CI remained higher in HD patients after adjustment for Hb, MAP, cSBP, PWV, AIx75, and LVMI (estimated marginal means 4.17, 95%CI 3.80-4.53 versus 3.40, 95%CI 3.11-369 in PD patients, p<0.05). Similarly, AIx75 remained higher in HD patients after adjustment for Hb, MAP, cSBP, PWV, CI, and LVMI (estimated marginal means 28.89, 95%CI 24.49-33.30 versus 22.62, 95%CI 19.15-26.08 in PD patients, p=0.05). Conclusion HD pediatric patients demonstrate higher AIx75 and CI compared to PD patients even in the absence of LVH. These results suggest distinct patterns of vascular and cardiac functional changes in HD patients that may increase cardiovascular risk beyond LVH.