P1284DIASTOLIC DYSFUNCTION IS A STRONG PREDICTOR OF MORTALITY IN DIALYSIS PATIENTS

Abstract

Abstract Background and Aims The prevalence of cardiovascular disease in dialysis patients is quite high. This is the leading mortality cause and the main reason for hospital admissions in this population. Diastolic dysfunction is an important predictor of cardiovascular events. The aim of this study is to calculate the prevalence of diastolic dysfunction (DD) and to identify any significant association of mortality and the grade of DD in chronic dialysis patients with preserved systolic function Method This is a prospective study of 310 consecutive patients who were enrolled from 2012-2019. All patients are dialysis dependent for chronic kidney disease (CKD) getting treatment at Nephrology-Dialysis &Transplantation Unit at Hygeia Hospital Tirana. LVH, diastolic dysfunction and cardiac valve pathology contributing to this were diagnosed by transthoracic echocardiography (TTE) criteria. DD was graded as: grade I (mild), grade II (moderate) and grade III (severe). The survival rate was analysed by Kaplan-Meier curves and Cox regression analysis. Results Mean age was 51.9±15.6 years; 62.6 % of pts were male, with a mean dialysis vintage of 49 months. 85 % of pts had preserved ejection fraction 50 % or more. LVH was observed in 79.1% of pts. LVED diameter (mm) 52±7 LVESd (mm) 33.7±6.8. Cardiac valve changes were diagnosed as follows: Aortic valve- 35% of patients resulted normal on ultrasound examination, 47% and 17% of pts had leaflet sclerosis and calcifications respectively with normal valve function. 25 % and 7% had some degree of aortic valve regurgitation and stenosis. Mitral valve examination resulted in 9% normal and in 84% of pts with some degree of regurgitation. Arterial hypertension was found in 95.1% of the patients. Diastolic dysfunction was detected in 55% of pts. Of them, 64.5% were deemed to have grade I diastolic dysfunction, 26.7% grade II, 8.7% grade III. During follow up, 25.5% of the patients with DD, died. The analysis of survival curve showed that grade III, 5.2 CI [3.86; 6.64], was associated with higher mortality compared with grade I 11.06 CI [10.01; 12.04] and grade II 11.65 CI [8.5; 14.8], p<0.001. Conclusion Diastolic dysfunction is ubiquitous echocardiography finding in patients treated with hemodialysis. Grade of diastolic disfunction tend to predict mortality of dialysis patients. 7-year survival analysis shows grade III to be associated with high mortality rates. A multidisciplinary approach is needed in order to predict, prevent and treat these conditions to improve outcomes.