SAT-213 Relationship of Cardiovascular disease with dialysis dosage

Abstract

Cardiovascular Disease (CVD) is the leading cause of death in End Stage Renal Disease (ESRD) patients on Maintenance Hemodialysis (MHD). The accumulation of uremic toxins play a part in the pathophysiology of cardiovascular disease that may progress to myocardial fibrosis, cardiomyopathy, left ventricular hypertrophy, vascular calcification and atherosclerosis. Thus, morbidity and mortality in hemodialysis patients is closely correlated to the delivered dialysis dose. The delivered dose is measured in MHD patients either by blood samples to calculate single pool Kt/V or by measuring the ionic dialysance in real time using online clearance monitoring (OCM). The aim of our study is to evaluate the influence of dialysis dose on the presence of CVD and to assess its relationship with echocardiographic parameters. 34 ESRD patients on MHD were included in the study from June 2019 to September 2019. Patients’ record, pre- and post- dialysis labs, Kt/V,OCM,URR, echocardiographic parameters including Left Atrial Volume Index (LAVI), Ejection Fraction (EF), Pulmonary Artery Systolic Pressure (PASP), presence of diastolic dysfunction and Left Ventricular Hypertrophy (LVH) were studied. Patients with a history of any cardiac event, a reduced EF or segmental wall motion abnormality on echocardiography were labelled as having CVD. Baseline echocardiographic measurements for each patient were analyzed. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 25. Of the 34 hemodialysis patients there were 16 females and 18 males with age ranging from 17 to 87 years and mean age of 59.6 years (table 1). Patients had MHD vintage ranging from half a month to 79 months with a mean vintage of 33.9 months. 55.9% of patients had CVD. 14.7%(5) patients had a Kt/V of <1.4 and 85.3% (29) had Kt/V of >1.4. Average EF of patients with CVD was 46.9% and without CVD was 55.1%. Presence of CVD correlated negatively with EF (r = -0.541, p=0.001). Mean LAVI was 40.3ml/m2. 82.4% patients had a LAVI of >34ml/m2. Markers of dialysis dose OCM (r= -0.467, p=0.005), KT/V (r= -0.405, p=0.017), URR (r= -0.364, p=0.034) correlated negatively with the presence of CVD. Patients with a Kt/V of <1.4 had a higher prevalence of CVD and diastolic dysfunction. as compared to patients with Kt/V of >1.4 (table 3). A higher PASP was prevalent in patients with lower Kt/V as compared to those with high Kt/V. Patients with a Kt/V of <1.4 had a higher prevalence of moderately enlarged LAVI (42-48 ml/m2). OCM had a significant negative correlation with LAVI (r= -0.359, p=0.037). However, there was no statistically significant correlation of Kt/V with any of the parameters on echocardiography.View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT) The presence of Cardiovascular disease is related to dialysis dose. Sub-optimal dialysis is associated with CVD. Many echocardiographic parameters were related to the dose of dialysis. Patients with a lower Kt/V had higher LAVI and PASP. There was also an increased presence of diastolic dysfunction in patients with lower Kt/V. Thus, clearance during dialysis can influence cardiac clinical and echocardiographic parameters.