Nephrology Dialysis Transplantation 29 (Supplement 3): iii481–iii490, 2014
doi:10.1093/ndt/gfu175
DIALYSIS CARDIOVASCULAR
COMPLICATIONS 2
MP451
CANDIDATE GENE ANALYSIS OF MORTALITY IN DIALYSIS
PATIENTS
T C Rothuizen1, G Ocak1, J JW Verschuren1, F W Dekker1, T J Rabelink1,
J W Jukema1 and J I Rotmans1
1
Leiden University Medical Center, Leiden, The Netherlands
Introduction and Aims: Dialysis patients have high mortality risk with cardiovascular
mortality as an important cause of death. Chronic kidney disease specific risk factors
implicated in these processes include chronic inflammatory state with up-regulation of
inflammatory cytokines and altered growth factor levels, altered calcium/phosphate
metabolism and coagulation as well as endothelial dysfunction. Alterations in the
genetic profile of these processes in dialysis patients may further increase this
dysbalance and enhance morbidity and mortality. The aim of this study was to
investigate the association between SNPs involved in the abovementioned processes
and cardiovascular and non-cardiovascular mortality in a large population of incident
dialysis patients.
Methods: We included 1330 incident dialysis patients in which 42 SNPs in 25 genes
involved in vascular processes (endothelial function and vascular remodeling, growth
factors, inflammation, coagulation, and calcium/phosphate metabolism) were
genotyped. Cox regression analysis was used to investigate the effect of these SNPs on
five-years mortality.
Results: The mortality rate was 114 per 1000 person-years for the 1330 dialysis
patients. Cardiovascular mortality accounted for 49,4% of these deaths, whereas 50,6%
(240/474) were not cardiovascular related. We found that VEGF rs2010963 and TNF
rs1799964 were protective for cardiovascular mortality in dialysis patients, whereas
VEGF rs699947 was associated with increased risk of cardiovascular mortality
(Table 1). In addition, MMP-1 rs11292517 and VDR rs2238135 were associated with
decreased risk of non-cardiovascular mortality, while rs9804922 in an intergenic region
on 12q23.2, CD180 rs5744478 and interleukin-6 rs1800795 were associated with an
increased non-cardiovascular mortality risk (Table 2). No significant associations with
mortality were observed with the other SNPs.
Conclusions: In this large cohort of dialysis patients, we found that two SNPs involved
in endothelial function and remodeling, three SNPs related to inflammatory processes,
two SNPs in genes encoding for growth factors, and one SNP related to vitamin D
metabolism were associated with mortality risk. This study provides further evidence
for an important role of these processes in the comorbid conditions of dialysis patients.
Future studies are warranted to unravel the underlying mechanisms responsible for the
increased mortality in these patients.
MP452
PREDICTORS OF CONGESTIVE HEART FAILURE EVENTS IN
INCIDENT PATIENTS ON HEMODIALYSIS - RESULTS FROM
THE INTERNATIONAL MONDO INITIATIVE
Viviane Silva1, Jochen G Raimann2, Aileen Grassmann3, Daniele Marcelli3,
Len Usvyat4,5, Bernard Canaud3, Peter Kotanko2, Roberto Pecoits-Filho6 and
Mondo Consortium5
1
Pontifícia Universidade Católica do Paraná, Curitiba, Brazil, 2Renal Research
Institute, New York, NY, 3Fresenius Medical Care, Bad Homburg, Germany,
4
Fresenius Medical Care North America, Waltham, MA, 5Renal Research
Institution, New York, NY, 6Pontifical University Catholic of Parana, Curitiba, Brazil
Introduction and Aims: Congestive heart failure (CHF) is highly prevalent in chronic
kidney disease (CKD) patients, particularly in those on dialysis. Although CHF is
clearly associated with high morbidity and mortality, predictors of CHF events have
not yet been described in large multinational cohorts. The aim of this study was to
explore predictors of CHF-related hospitalization and mortality in the MONitoring
Dialysis Outcomes [MONDO] consortium cohort.
Methods: MONDO consists of hemodialysis (HD) databases from multiple dialysis
providers [Usvyat, Blood Purif 2013; von Gersdorff, Blood Purif 2014]. We identified
all patients in the Fresenius Medical Care Europe data base [17 countries] with
in-center treatments between 1/2006 and 12/2012 who survived at least one year on
HD. Hospitalizations and causes of death were classified as CHF related according to
ICD-10 codes. The mean of clinical and laboratory parameters were computed for the
first 12 months (baseline) and hospitalizations and CHF-related clinical events (deaths
and hospitalizations) were observed in the following 12 months (follow up period).
Poisson regression models were constructed to explore associations between baseline
parameters and the number of CHF events in the follow up period.
Results: We studied 11,644 patients. Caucasian patients appeared to have lower risk of
CHF-related hospital admissions. Longer treatment time and higher albumin levels
were associated with lower risk of CHF-related events. Inflammatory markers
(neutrophil to lymphocyte ratio; CRP (data not shown)) were not associated with CHF
events.
Conclusions: In the European MONDO cohort, younger age, Caucasian race, better
nutritional status and longer HD treatment times were associated with lower risk of
CHF=related hospitalization or mortality, while inflammatory markers or blood
pressure were not. These findings may assist the screening for patients at high risk for
CHF-related complications and help to define targets for interventions in HD patients
with CHF.
MP451
MP452
MP453
MP451
ASSOCIATION OF PERIODONTITIS WITH ALL-CAUSE AND
CARDIOVASCULAR MORTALITY IN ADULTS WITH
END-STAGE KIDNEY DISEASE: A MULTINATIONAL COHORT
STUDY
On Behalf Of The ORAL-D Investigators and Giovanni FM Strippoli1
1
Fondazione Mario Negri Sud, S Maria Imbaro, Sweden
© The Author 2014. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
Abstracts
Introduction and Aims: Oral disease is highly prevalent in the general population and
represents a potential and reversible determinant of poor health in dialysis patients.
Periodontitis is associated with adverse cardiovascular events in healthy adults but the
link between periodontal disease and clinical outcomes in individuals with end-stage
kidney disease is poorly understood. We aimed to evaluate the association between
periodontitis and all-cause and cardiovascular mortality in dialysis patients.
Methods: We conducted a prospective multinational cohort study in 4320 individuals
with end-stage kidney disease treated with hemodialysis (the ORAL-D study).
Periodontitis was evaluated at baseline in all dentate patients (N=3337) in a
standardized dental examination and periodontitis severity was categorized according
to the community periodontal index of the World Health Organization. The primary
outcomes were all-cause and cardiovascular mortality. Risks of mortality were
calculated using Cox proportional hazards regression analyses stratified by country and
controlled for age, gender, and time on dialysis.
Results: 3337 adults (mean age 59.1 years, 59% men) were dentate at baseline. Overall,
203 (6.1%) dentate patients had no periodontitis, 101 (3.0%) had mild periodontitis,
114 (3.4%) had moderate periodontitis, and 2919 (87.5%) had severe periodontitis.
During a median follow up of 24.2 months, 650 deaths and 325 cardiovascular deaths
occurred. In univariate analyses, periodontitis was associated with decreased all-cause
(HR 0.51 [CI, 0.39-0.65]) and cardiovascular mortality (HR 0.55 [CI 0.43-0.71])
(Figure) and there was a dose-response relationship showing increasing periodontitis
severity was associated with better survival ( p for trend<0.001 for both). Periodontitis
was independently associated with a lower risk of all-cause mortality (0.75 [CI
0.57-0.98]) when adjusted for potentially confounding variables, but not cardiovascular
mortality (0.75 [CI 0.53-1.08]). Similarly, compared to no periodontitis, increasing
disease severity was associated with lower all-cause mortality ( p=0.009) but not
cardiovascular mortality ( p=0.49).
Conclusions: Periodontitis predicts longer survival in adults with end-stage kidney
disease. These data suggest periodontitis may be a surrogate marker of better health
status in dialysis patients, is a further example of reverse epidemiology in this clinical
setting, or is an explanatory variable that warrants further exploration to understand
the mechanisms contributing to death in dialysis patients.
MP453
MP454
BETA-BLOCKER IMPROVES SURVIVAL IN HEART FAILURE
PATIENTS WITH LONG-TERM HEMODIALYSIS: A
POPULATION-BASED STUDY IN TAIWAN
Yuh-Mou Sue1,2, Chao-Hsiun Tang2, Tso-Hsiao Chen1 and Chuang-Ye Hong1
1
Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, 2Taipei Medical
University, Taipei, Taiwan
Introduction and Aims: Heart failure is among the most frequent complications of
patients on long-term hemodialysis. The benefits of β-blocker (BB) on the outcomes of
heart failure (HF) patients with long-term hemodialysis (HD) remain unclear.
Methods: We used 1999-2010 data from the Taiwan National Health Insurance
Research Database to conduct an observational study. We used International
Classification of Diseases, 9th Revision, Clinical Modification codes to enroll long-term
HD patients aged ≥ 35 years with new onset HF being treated with medications. New
users of BB were selected to compare 5-year all-cause and cardiovascular mortality
with non-BB users after propensity-score adjustment. We used Cox proportional
hazards regression with and without propensity score adjustment to compare the risk
of 5-year all-cause and cardiovascular mortality. We also performed time-dependent
covariate analyses by using BB therapy duration.
Results: Totally, 4439 patients were treated with BB (n = 3023) or without BB (n =
1416). Among BB users, 1294 deaths (42.8%) occurred during 6741 person-years of
follow-up compared with the 820 deaths (57.4%) among non-BB users during 2113
person-years of follow-up. The 5-year mortality rates were 57.3% and 74.1% for
patients receiving and those not receiving BB, respectively ( p < 0.001). The 5-year
cardiovascular mortality rates were 25.4% and 34.1% for patients receiving and those
not receiving BB, respectively ( p < 0.001). Adjusted hazard analysis revealed that the
therapeutic effects of BB remained significant for all-cause [hazard ratio (HR), 0.90;
95% confidence interval (CI), 0.81-0.99; p < 0.05] and cardiovascular mortality (HR,
0.89; 95% CI, 0.80-0.98; p < 0.05). Subgroup analysis indicated that BB users with
carvedilol, bisoprolol, or metoprolol succinate had better all-cause and cardiovascular
survival than those without these three BBs.
Conclusions: BB therapy reduces all-cause and cardiovascular mortality in HF patients
with long-term HD.
iii | Abstracts
Nephrology Dialysis Transplantation
MP455
SERUM β2 MICROGLOBULIN CORRELATES POSITIVELY
WITH LEFT VENTRICULAR HYPERTROPHY IN LONG-TERM
HEMODIALYSIS PATIENTS
Akinobu Ochi1, Eiji Ishimura1, Mio Masuda1, Yoshihiro Tsujimoto2, Senji Okuno3,
Tsutomu Tabata2, Yoshiki Nishizawa1 and Masaaki Inaba1
1
Osaka City University Graduate School of Medicine, Osaka, Japan, 2Inoue
Hospital, Osaka, Japan, 3Shirasagi Hospital, Osaka, Japan
Introduction and Aims: β2-microgloblin (β2-MG) is a polypeptide that comprises
human leukocyte antigen (HLA) class1. Its molecular weight is 11,800 Da, and it is
classified as a mid-molecular weight uremic toxin. Long-term exposure to serum
β2-MG is considered to cause not only osteoarticular amyloidosis, but also leads to
systemic amyloidosis. Amyloid deposition in the heart has been reported in long-term
hemodialysis patients. However,the effects of serum β2-MG concentrations on the
heart in long-term hemodialysis patients are not well known. In the present study, we
examined the relationships between serum β2-MG concentrations and
echocardiographic parameters in patients undergoing long-term hemodialysis.
Methods: We performed a cross-section study on 251 patients with long-term
hemodialysis duration for more than 10 years. We excluded diabetic patients. The
patients underwent hemodialysis therapy three times a week. Blood examination and
echocardiography were performed before the start of the hemodialysis session. Serum
β2-MG concentrations were measured by the latex coagulating method. We measured
the left ventricular end-diastolic dimension (LVDd), posterior left ventricular wall
thickness (PWT), interventricular septum thickness (IVST), left ventricular wall
thickness (LVWT), relative wall thickness (RWT), left ventricular mass index (LVMI)
and ejection fraction (EF). To compare LVMI between the higher serum β2-MG group
(β2-MG ≥ 30mg/L) and the lower serum β2-MG group (β2-MG < 30mg/L), unpaired
Student’s t-test was used. Simple and multiple regression analyses were performed to
evaluate the relationships between serum β2-MG concentrations and echocardiography
parameters.
Results: The median (25th-75th) hemodialysis duration was 18.8 (14.0 - 25.1) years.
The mean (± SD) serum β2-MG concentrations were 27.3 (± 6.4) g/L. At first, we
compared LVMI between the higher serum β2-MG group (β2-MG ≥ 30mg/L) and the
lower serum β2-MG group(β2-MG < 30mg/L). TheLVMI of the higher serum β2-MG
group was significantly higher than that of the lower serum β2-MG group (151.5 ± 45.7
mg/L vs. 137.0 ± 44.5 mg/L, p = 0.020) . Next, we examined the relationships between
serum β2-MG concentrations and the echocardiographic parameters. In simple
regression analyses, serum β2-MG concentrations correlated significantly and
positively with IVST (r = 0.215, p < 0.001), PWT (r = 0.249, p < 0.001), LVWT (r =
0.252, p < 0.001), RWT (r = 0.153, p= 0.015) and LVMI (r = 0.171, p = 0.007). There
were no significant correlations between serum β2-MG and LVDd (r = 0.038, p =
0.544) or between serum β2-MG and ejection fraction (r = 0.006, p = 0.924). Multiple
regression analyses revealed that serum β2-MG concentrations correlated significantly
and positively with PWT (β = 0.219, p = 0.002), IVST (β = 0.141,p = 0.042), LVWT (β
= 0.193, p = 0.005) and RWT (β = 0.207, p = 0.005), after adjusted by age, gender,
hemodialysis duration, presence of hypertension, use of angiotensin-converting
enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) and hemoglobin.
However, β2-MG did not correlate significantly with LVMI (β = 0.087, p = 0.215) in
the multiple regression analysis.
Conclusions: Serum β2-MG concentrations correlated significantly and positively with
the parameters associated with left ventricular hypertrophy (LVH), independent of
other clinical parameters. These results suggest that the deposition of β2-MG amyloid
into the heart may be associated with LVH in long-term hemodialysis patients.
MP456
IDEAL SCREENING TOOLS FOR CORONARY ARTERY
DISEASE IN DIALYSIS PATIENTS; AN ANGIOGRAPHIC
EXAMINATION
Hong Moon Ki1, Kim Do Hyoung1, Han Min Jee1, Kang Hyun2, Lee Wang Soo3
and Kim Su-Hyun1
1
Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic
of Korea, 2Department of Anesthesiology and Pain Medicine, Chung-Ang
University College of Medicine, Seoul, Republic of Korea, 3Heart Center,
Chung-Ang University Hospital, Seoul, Republic of Korea
Introduction and Aims: Screening for coronary artery disease in dialysis patients is
important, because of high cardiovascular mortality in dialysis patients. But there were
no defined consensus for screening methods, therefore we studied the clinical effect for
coronary angiography (CAG) as a screening tool for coronary artery disease (CAD) in
dialysis patients.
Methods: A total of 120 patients who were undergoing dialysis patients (hemodialysis,
n= 113, peritoneal dialysis, n= 7) were enrolled in this study. We evaluated the
prevalence of coronary artery disease between three groups, and diagnostic values of
non-invasive test were measured by using coronary angiography as the gold standard.
The survival rate of patients was explored using a Cox proportional hazards regression
models.
Results: The patients were divided into three groups according to ischemic heart
disease related symptoms and performance of CAG; Group 1 (symptoms without
CAG, n= 58), Group 2 (symptoms with CAG, n=42) and Group 3 (no symptoms with
CAG, n=20). Among 62 dialysis patients who underwent CAG (Group 2 and 3),
Volume 29 | Supplement 3 | May 2014
Abstracts
Nephrology Dialysis Transplantation
prevalence of CAD was 52(83.9%) and there were no statistically different between two
groups. The accuracy of non-invasive diagnostic test was measured by using coronary
angiography as the gold standard, regional wall motion abnormality on resting
echocardiography showed comparatively good sensitivity (65.38%) and specificity
(80%), but its sensitivity was less than clinical symptoms (69.2%). Electrocardiography
and chest X-ray showed low sensitivity (40.4%). Specificity of Troponin I (≥ 0.8 ng/
mL) showed highest (90%) but low sensitivity (40.4%). Cardiovascular mortality rate
was significantly higher in Group 1 than in Group 2 ( p=0.049) and Group 3 ( p=0.045).
In the univariate analysis, age (hazard ratio [HR] 2.94, 95% confidence interval [CI]
1.10-7.86, p=0.031), performance of CAG (3.02, 1.26-7.24, p=0.013), troponin-I (3.69,
1.62-8.40, p=0.002), electrocardiography abnormalities (2.57, 1.16-5.68, p=0.020), total
cholesterol (2.28, 1.02-5.09, p=0.045) showed independent predictors of cardiovascular
mortality. We performed multivariate Cox proportional hazard analysis after adjusting
the independent predictors in the univariate analysis, performance of CAG (HR 4.16,
95% CI 1.44-11.98, p = 0.017) and troponin-I (4.78, 1.55-14.72, p = 0.006) showed
significant correlated with cardiovascular deaths.
Conclusions: This report suggests that performance of CAG as a screening test for
CAD in dialysis patient may further improve cardiovascular survival rate.
Results: During a mean follow-up duration of 27.2 months, 57 patients (29.4%)
experienced CV events. Compared to CV event-free group, left ventricular (LV) mass
index (LVMI), E/E’, LA volume index (LAVI), deceleration time (DT), and right
ventricular systolic pressure (RVSP) were significantly higher, while LV ejection
fraction (LVEF) and E’ were significantly lower in patients with CV events. In
multivariate Cox proportional hazard analysis, LVEF, E/E’, LAVI, E/E’ > 15, and LAVI
> 32 mL/m2 were demonstrated to be significant independent predictors of CV events
even after adjusting for clinical and laboratory parameters. Among these, E/E’ > 15 and
LAVI > 32 mL/m2 had significant power to predict CV events [E/E’ > 15: hazard ratio
(HR) = 5.40, 95% confidence interval (CI) = 2.73-10.70, P < 0.001; LAVI > 32 mL/m2:
HR = 5.56, 95% CI = 2.28-13.59, P < 0.001]. In addition, E/E’ and LAVI provided
higher predictive values for CV events than other echocardiographic parameters.
Kaplan-Meier analysis revealed that patients with both E/E’ > 15 and LAVI > 32mL/m2
had the worst CV outcomes.
Conclusions: Both elevated E/E’ and high LAVI were significant risk factors for CV
events in incident dialysis patients with preserved LV systolic function.
MP459
MP457
SERUM MAGNESIUM CONCENTRATION AND MORTALITY IN
HEMODIALYSIS PATIENTS: 5 YEAR FOLLOW-UP ANALYSIS
Gjulsen Selim1, Olivera Stojceva-Taneva1, Liljana Tozija1,
Pavlina Dzekova-Vidimliski1, Lada Trajceska1, Saso Gelev1, Vili Amitov1,
Zvezdana Petronievic1 and Aleksandar Sikole1
1
University Clinic of Nephrology, University “Sts. Cyril and Methodius”, Skopje,
Republic of Macedonia
Introduction and Aims: Although hypomagnesemia predicts cardiovascular (CV)
morbidity and mortality in the general population, the impact of magnesium (Mg) on
the prognosis of patients on hemodialysis (HD) has been poorly investigated. The aim
of this study was to elucidate the association between serum Mg levels and mortality in
HD patients in a five year follow-up analysis.
Methods: We studied a cohort of 185 prevalent HD patients (mean age at beginning of
HD 49.74±14.71 years, mean HD vintage 99.86±65.73 months, diabetes 17.3%)
receiving thrice-weekly HD treatment, with a dialysate Mg concentration of 0.5mmol/l.
The mean values of minimum twelve serum Mg measurements during the six months
before follow-up were used for analysis. Patients were divided into two groups
according to the upper reference value of serum Mg concentration:a lower Mg group
(Mg<1.11mmol/l) and a higher Mg group (Mg≥1.11mol/L) and were prospectively
followed up for 60 months.
Results: During the 5-year follow-up, 60 out of 185 patients (32.4%) had died, most
from CVD (73.3%). The mean serum Mg level was 1.23±0.15 mmol/L (0.831.73moml/L). The patients with serum Mg<1.11mmol/L were significantly different
than those with serum Mg≥1.11mol/L regarding age (54.80±13.66 vs 48.72
±14.74years, p=0.035), diastolic blood pressure (86.27±17.01 vs. 80.67±13.94mmHg,
p=0.04), hemoglobin (98.27±14.31 vs 108.63± 10.54g/l, p=0.000), creatinine (850.80
±236.15 vs 938.50±184.01μmol/L, p=0.022), C-reactive protein (25.03±25.66 vs 12.57
±21.31 mg/L, p=0.004), brain natriuretic peptide (4822.91±9293.05 vs 1343.00
±1409.86 pg/ml, p=0.000) and left ventricular mass index (164.41±77.79 vs 136.46
±44.67 g/m2, p=0.016). Patients who died of all-causes had lower Mg concentration
(1.19±0.16 vs. 1.25±0.15, p=0.007), as well as patients who died of CV causes (1.18
±0.15 vs 1.25±0.15, p=0.011). Kaplan-Meier analysis showed that all cause mortality
(log rank, p=0.001) and CV mortality (log rank, p=0.002) were significantly higher in
the lower Mg group (<1.11 mmol/L), compared to that in the higher Mg group (≥1.11
mmol/l).
Conclusions: This study showed that serum Mg level <1.11mmol/l is a significant
predictor for all-cause and cardiovascular mortality in HD patients, although the
mechanisms and the optimal magnesium levels in uraemic patients remain to be
explored in future studies.
MP458
DIASTOLIC DYSFUNCTION IS AN INDEPENDENT
PREDICTOR OF CARDIOVASCULAR EVENTS IN INCIDENT
DIALYSIS PATIENTS WITH PRESERVED SYSTOLIC
FUNCTION
Youn Kyung Kee1, Yung Ly Kim1, Jae Hyun Han1, Hyung Jung Oh1, Jung
Tak Park1, Seung Hyeok Han1, Tae-Hyun Yoo1 and Shin-Wook Kang1
1
Yonsei University College of Medicine, Seoul, Republic of Korea
Introduction and Aims: Diastolic heart failure (HF), whose prevalence is steadily
increasing, is associated with cardiovascular (CV) morbidity and mortality in not only
the general population but also patients with end-stage renal disease (ESRD). However,
the impact of diastolic dysfunction on the CV outcomes has never been explored in
incident dialysis patients with preserved systolic function.
Methods: This prospective observational cohort study was undertaken to investigate
the clinical consequence of diastolic dysfunction and the predictive power of diastolic
echocardiographic parameters for CV events in 194 incident ESRD patients, who
started maintenance dialysis between July 2008 and August 2012 and had normal or
near normal systolic function.
Volume 29 | Supplement 3 | May 2014
CARDIOTHORACIC RATIO (CTR) AND NT-PROBNP AS
PREDICTORS OF CARDIOVASCULAR DISEASE (CVD) IN A
HEMODIALYSIS COHORT
Yujiro Okute1, Tetsuo Shoji1, Mika Sonoda1, Yukinobu Kuwamura1,
Yoshihiro Tsujimoto2, Tsutomu Tabata2, Atushi Shioi1, Hideki Tahara1,
Masanori Emoto1 and Masaaki Inaba1
1
Osaka City University Graduate School of Medicine, Osaka, Japan, 2Inoue
Hospital, Osaka, Japan
Introduction and Aims: NT-proBNP, a serum biomarker for cardiac hypertrophy, is a
predictor for CVD events and mortality. We investigated whether CTR, an indicator of
cardiac enlargement on chest X-ray, is also useful as a CVD risk predictor in
hemodialysis patients.
Methods: This is a cohort study of 515 maintenance hemodialysis patients in an urban
area in Japan.
Results: CTR showed a positive correlation with NT-proBNP at baseline. We identified
188 CVD events during the 5-year follow-up. Kaplan-Meier curves indicated that both
CTR and NT-proBNP were significant predictors for CVD. In multivariate Cox
models, the associations of both CTR and NT-proBNP with CVD risk remained
significant after adjustment for age, sex, dialysis vintage, diabetes, and other relevant
confounders. In models CTR and NT-proBNP were simultaneously included,
NT-proBNP was significantly associated, but CTR was not, with risk of CVD.
Conclusions: CTR is useful in CVD-risk stratification in hemodialysis patients,
although NT-proBNP is better for this purpose.
MP460
ABDOMINAL AORTIC CALCIFICATIONS ARE A PREDICTOR
OF CORONARY ARTERY CALCIFICATIONS IN HEMODIALYSIS
Mohamed El Amrani1, Mohammed Asserraji2 and Mohammed Benyahia1
1
Military Teaching Hospital Mohammed V, Rabat, Morocco, 2First Medical and
Surgical Center, Agadir, Morocco
Introduction and Aims: Cardiovascular disease is the first leading cause of death in
hemodialysis patients. In this population, cardiovascular calcifications occur at an
earlier age and are growing faster than in the general population.
Methods: Forty-nine patients on chronic hemodialysis , 26 men and 23 women , mean
age 56.4 years , with an average duration in hemodialysis of 85 months have been
screened for coronary artery calcification (CAC ) by a 64 multislice ultra -fast
cardioscanner, and for calcifications of the abdominal aorta (CAA) using lateral
abdominal X-ray (LAX).
Results: The CAA were present in 51 %. of cases, and CAC in 69.4 % of cases. CAC are
present in 88 % of patients with CAA patients. There is a significant difference in
coronary calcium score (CCS) between patients with and without CAA (394.6 vs 58, p
= 0.003). Similarly, the aortic calcium score (SCA) was significantly lower in patients
without CAC in comparison to those with CAC (0.4 vs 5.35, p = 0.006) . There was a
significant positive correlation between CSC and the SCA.
Conclusions: Our results confirm the increased frequency of vascular calcification in
hemodialysis patients. Several studies have shown that the CAA correlate with CAC
which in turn are a predictor of all-cause mortality. In addition, the severity of these
calcifications are a major predictor of cardiovascular morbidity and mortality
highlighting the need for early screening and regular monitoring because of the risk of
progression.LAX is an easy and inexpensive method that may be a useful alternative for
CT-based techniques in epidemiological studies in patients with CKD. Furthermore, it
may serve as a part of the cardiovascular risk assessment and as a guide to more
sophisticated examinations.
MP461
PRESENTATION AND TREATMENT OF CALCIFIC URAEMIC
ARTERIOLOPATHY IN PATIENTS WITH END-STAGE RENAL
FAILURE: A SINGLE-CENTRE EXPERIENCE
Peter A Galloway1, Vivian Yiu1 and Thomas F Hiemstra1
doi:10.1093/ndt/gfu175 | iii
Abstracts
1
University of Cambridge, Cambridge, United Kingdom
Introduction and Aims: Calcific Uraemic Arteriolopathy (calciphylaxis) is a rare
disorder characterised by small vessel and soft tissue calcification. Those with renal
failure, poorly controlled mineral and bone disorder, diabetes or treatment with
warfarin are most at risk. Calciphylaxis portends a poor prognosis with reported
mortality of at least 60%. However, emerging treatments including sodium
thiosulphate and calcimimetic agents may improve outcomes.
Methods: We reviewed all cases diagnosed with calciphylaxis at Addenbrooke’s
Hospital, Cambridge, between December 2009 and December 20013. Patients were
identified from electronic hospital records. We describe the presentation, management
and outcomes of five cases from a single nephrology centre. Data are presented as mean
± SD or median (IQR) as appropriate.
Results: During the study period, 5 female patients aged 66 ± 12 years were diagnosed
with calciphylaxis. Diagnosis was confirmed by histology in all cases. Patients had a
dialysis vintage of 6.6 ± 11.7 years, although one patient with a dialysis vintage of 26
years had received her third kidney transplant two months before developing
calciphylaxis. At diagnosis, patients had a plasma albumin-corrected calcium
concentration of 2.23 ± 0.25 mmol/l, phosphate of 1.12 ± 0.43 mmol/l, parathyroid
hormone concentration of 47. Four patients were receiving warfarin, which was
stopped in all patients; 2/4 subsequently received dabigatran, and one long term
dalteparin. Treatment included discontinuation of calcium-containing phosphate
binders, intravenous sodium thiosulphate (4/5 patients) and cinacalcet (4/5 patients),
along with optimization of dialysis adequacy. Sodium thiosulphate had to be
discontinued in two patients due to nausea and vomiting. One patient required lower
limb amputation and has subsequently remained well without any evidence of
recurrence; the remaining patients had rapid resolution of symptoms with complete
recovery within the follow-up period.
Conclusions: We describe a full recovery in all patients with calciphylaxis treated at our
centre since December 2009. Our data support growing evidence of the procalcific
effects of warfarin, and suggest that a multimodal treatment strategy including sodium
thiosulphate and calcimimetic therapy may improve symptoms and outcomes in
caliphylaxis.
MP462
Nephrology Dialysis Transplantation
months, 12 months before start of study). Baseline characteristics of all patients before
the start of second phase are given in table 1. After the first phase, hipotensive prone
patients received dialysis with sodium profiling (145-138 mmol/L) and other two
groups received dialysis with individualized sodium. Variables of interest were: sistolic,
diastolic and mean blood pressure, pulse, IDWG (interdialytic weight gain), thirst score
(Xerostomia Inventory (XI) and Dialysis Thirst Inventory (DTI)) and side effects
(episodes with hipotension and muscle cramps).
Results: Sodium individualization resulted in significantly lower blood presure and
IDWG in hipertensive patients compared to standard sodium. Sodium profiling in
hipotensive prone patients significantly increase IDWG (2.06 vs 2.21, p= 0,020)
compared to standard sodium, but with no statical significant change in blood presure
(table 1). Normotensive patients with higher than 138 mmol/l dialysate sodium had no
statistical significant change in SBP ( p=0.488), DBP ( p=0.895), MAP ( p=0.777) and
pulse ( p=0.303), but with significant increase in IDWG (1.92 vs 1.70 p=0.019)
compared to standard dialysed sodium. Dialysate sodium equal or lower than 138
mmol/L in stabile normotensive patients had no significant influence on blood presure
compared to standard sodium, but significantly decrease pulse (70.39 vs 73.29,
p=0.000) and IDWG (2.09 vs 2.28, p=0.000). Analysis of subjective feeling of thirst and
dry mouth in both phase among analyzed groups of patients is given in table 1. During
the second phase only 1 episodes of hipotension and 10 cases of muscle cramps were
noted in normotensive patients, while the other patients didn’t complain on side
effects.
Conclusions: The optimal dialysate sodium is not well definite and it’s depend of
clinical circumstances. In hipertensive and stabile normotensive patients isonatremic
or dialysis with lower dialysate sodium should be performed. Higher dialysate sodium
in stabile patients and sodium profiling in hipotensive prone patients increase IDWG,
but with no influence on blood presure, suggesting that some other factors are involved
what require more investigations.
RISK FACTORS FOR STROKE IN HEMODIALYSIS PATIENTS
Camilla Nilssen1, Faiez Zannad2, Alan Jardine3, Roland Schmieder4,
Bengt Fellstrøm5, Hallvard Holdaas1, Geir Mjoen1 and On Behalf of The AURORA
Study Group
1
Oslo University Hospital, Oslo, Norway, 2Nancy University, Nancy, France,
3
University of Glasgow, Glasgow, United Kingdom, 4University Hospital Erlangen,
Erlangen, Germany, 5University Hospital Uppsala, Uppsala, Sweden
Introduction and Aims: There are uncertainties regarding risk factors for ischemic
cerebral stroke in hemodialysis patients. We assessed possible associations in a post hoc
analysis of the AURORA trial.
Methods: AURORA was a randomized, double-blind, placebo-controlled study to
investigate the effect of rosuvastatin on cardiovascular outcomes and mortality in
hemodialysis patients. We investigated the relationship between potential risk factors at
baseline and a combined outcome of ischemic cerebral stroke and death from ischemic
stroke using Cox regression.
Results: In total, 2773 patients with median age of 64 years at baseline were available
for analysis. Mean time on dialysis at inclusion was 3.5 years. During a median
follow-up of 3.8 years, there were 105 events. Ischemic cerebral stroke was significantly
associated with age (HR 1.03, CI 1.01-1.05), albumin (HR 0.90 CI 0.85-0.96), diabetes
(HR 1.72 CI 1.11-2.66), current smoking (HR 2.10, CI 1.30-3.40) and dialysis vintage
(HR 1.04 CI 1.00-1.09). No associations were found for gender, systolic blood pressure,
phosphate, body mass index and LDL-cholesterol.
Conclusions: Several risk factors were associated with ischemic stroke. Nutritional
status and smoking are potentially modifiable risk factors.
MP463
CLINICAL EFFECT OF STANDARD AND INDIVIDUALIZED
SODIUM ON CHRONIC HEMODIALYSIS PATIENTS
Natasa Eftimovska - Otovic1, Elena Babalj - Banskolieva2, Srdanka Bogdanoska Kostadinoska2 and Risto Grozdanovski2
1
Special Hospital for Nephrology and Dialysis Diamed Skopje, Skopje, Republic of
Macedonia, 2Special Hospital for Nephrology and Dialysis Diamed, Skopje,
Republic of Macedonia
Introduction and Aims: Prescription of dialysate sodium still remain unclear question
for chronic hemodilaysis patients. Will patients have some beneficial effects of dialysate
sodium set up according to serum sodium or sodium profiling is the aim of the study.
Methods: In the study were included 92 non- diabetic subjects (men 52; women 45),
with dialysis vintage 78.91±67.52 months, on high flux bicarbonate dialysis, frequency
3 time/week and residual renal function below 300 ml/day. In the first phase patient
performed 12 connsecutive HD sessions (4 weeks) with dialysate sodium concetration
set up on 138 mmol/L (standard sodium), followed by 24 sessions (second phase)
wherein dialysate sodium was set up according to average pre - HD plasma sodium
(individualized sodium - meassured pre-HD plasma sodium concentration every
iii | Abstracts
MP463
MP464
DIALYSATE WITH HIGH BICARBONATE CONTENT MAY
WORSEN CARDIAC PERFORMANCE DURING
HEMODIALYSIS SESSIONS
Bruno C Silva1, Geraldo R Freitas1, Vitor B Silva1, Hugo Abensur1,
Claudio Luders1, Benedito J Pereira1, Manuel CM Castro1, Rodrigo B Oliveira1,
Rosa MA Moyses1 and Rosilene M Elias1
1
University of São Paulo, São Paulo, Brazil
Introduction and Aims: Bicarbonate buffer is used worldwide to correct acidosis in
chronic kidney disease (CKD) patients under hemodialysis (HD) treatment. However,
deleterious effects of rapid alkalosis induction on the cardiovascular system as a
consequence of this treatment are still unknown.
Methods: This was a prospective observational cohort to evaluate the effects of
dialysate with high bicarbonate content on cardiovascular performance in CKD
patients, under HD treatment. Finger pulse contour analysis (Finometer monitor™)
was used to access hemodynamic parameters immediately pre and post HD sessions.
Results: 30 patients on HD were enrolled. Mean age was 39.6 ± 11.3 years, 57% were
male. Diabetes was an exclusion criterion. Ten patients (33%) were taking β-blocker
and 9 patients (30%) were taking angiotensin receptor blocker. Baseline and post
dialysis hemodynamic and biochemical variables are described in Table 1. Mean
ultrafiltration rate (UF) was 11.2 ± 4.4 ml/kg/h, and serum bicarbonate variation was
8.9 ± 3.7 mEq/L. Median of serum-dialysate gap of Na+ (Na+ gap) was +2.0 mEq/L
(-2.0, 5.2). Physiological response to UF ( post dialysis cardiac index drop and
peripheral arterial resistance increase) was observed. Cardiac index (CI) variation ( post
minus pre dialysis value) was -0.625 L/min/m² (-1.280, 0.297) and peripheral arterial
resistance variation was +229.0 (19.5, 408.0) dyn.s/cm5. The drop in CI was correlated
to the serum-dialysate K+ gap (K+ gap), as well as to the bicarbonate content, and the
Na+ gap (Figure 1). In multiple regression analysis, dialysate with high bicarbonate content
or higher K+ gap remained as an independent predictor of worsening post HD CI drop
(p=0.002 and 0.004, respectively, with adjusted r2=0.426). In addition, further multiple
regression model shows that either lower Na+ gap or the higher K+gap, exert impact on
the worsening of CI drop (p=0.022 and 0.004, respectively, with adjusted r2=0.357).
Volume 29 | Supplement 3 | May 2014
Abstracts
Nephrology Dialysis Transplantation
Conclusions: Dialysate prescription influences hemodynamic behavior during HD
procedure. We suggest that increasingly positive bicarbonate balance may exacerbate
the expected CI drop after HD procedure, independent of K+ gap. The same was
observed with lower Na+ gap. Further investigations to reveal the optimal composition
of dialysate bicarbonate and sodium content, and the effect of K+ on hemodynamic
changes during HD are needed.
MP464 Hemodynamic parameters influenced by dialysis with high bicarbonate
content
Hemodynamic parameter
Pre-HD
Post-HD
p
Systolic blood pressure (mmHg)
Diastolic blood pressure (mmHg)
Serum bicarbonate level (mEq/L)
Serum potassium level (mEq/L)
Stroke volume (ml)
Cardiac index (L/min/m²)
Peripheral arterial resistance (dyn.s/cm5)
133.2 ± 23.8
74.5 ± 12.2
20.7 ± 3.4
5.2 ± 0.5
90.0 ± 27.4
3.93 ± 0.89
1277 ± 431
121.9 ± 25.4
74.5 ± 13.6
29.6 ± 3.3
3.8 ± 0.5
65.7 ± 29.0
3.20 ± 0.82
1549 ± 632
0.0003
0.990
<0.0001
<0.0001
<0.0001
<0.0001
0.0003
MP465
CONICITY INDEX PREDICTS CARDIOVASCULAR EVENTS IN
HEMODIALYSIS
Ana Pérez De José1, Soraya Abad1, Almudena Vega1, Javier Reque1,
Borja Quiroga1 and Juan Manuel López-Gómez1
1
Hospital Gregorio Marañón, Madrid, Spain
Introduction and Aims: The role of obesity on outcome in hemodialysis (HD)
patients remains unclear. Some studies, which measure obesity by body mass index
(BMI), suggest that obesity may be beneficial in HD. BMI does not discriminate on the
distribution of body fat. Conicity index (CI) assesses the degree of abdominal adiposity.
The aim of the present study is to determine whether abdominal obesity measured by
CI and by fat tissue index (FTI) is associated with cardiovascular events in HD patients.
Methods: The study group consisted of 100 patients on maintenance HD (60% men,
60 years old, 34% diabetes, 8.9 years in dialysis, kt/v 1.57). Patients were prospectively
followed-up for 3 years. Adiposity indicators evaluated were: BMI, CI and FTI which
was assessed by bioimpedance spectroscopy. Insulin - resistance was measured with
HOMA index. Cardiovascular events and mortality were prospectively collected.
Kaplan Meier analysis was performed to study the effect of increased BMI, CI and FTI
in cardiovascular events. We divided patients into 2 groups according to the median of
BMI, CI and FTI. Cox regression model was performed to determine which factors
were associated with cardiovascular events.
Results: Cardiovascular events are increased in patients with CI greater than 1.2 (log
rank 6,393 , p = 0.011) and FTI greater than 11.5 kg/m2 ( Log Rank 10,220 , p < 0.001).
Increased BMI is not associated with cardiovascular events. Patients with greater CI
and FTI have a significantly higher HOMA index ( p = 0.018 and p < 0.001
respectively). Survival at 3 years in patients with CI greater than 1.2 is 42 % and in
patients with CI lower than 1.2 is 70 %. In Cox regression model, adjusted for age and
sex, CI predicts cardiovascular events in HD (OR 8.46, 95% CI 1.14 to 62.91, p = 0.037
) and the so does FTI (OR 2.8, 95% CI 1.2-6.7 ). Mortality was 35% at 3 years follow-up
with no differences between groups (CI greater and lower than 1.2).
Conclusions: Abdominal obesity is associated with cardiovascular events in HD
patients. BMI does not predict cardiovascular events. CI and FTI are independent
predictors of cardiovascular events in HD possibly linked to endocrine - metabolic
disorders associated with abdominal obesity.
MP466
PROGNOSTIC VALUE OF CAROTID INTIMA−MEDIA
THICKNESS FOR CARDIOVASCULAR AND ALL−CAUSE
MORTALITY IN PATIENTS BEGINNING HAEMODIALYSIS.
Koichi Sasaki1, Kei Yamguchi1, Atsushi Hesaka1, Eriko Iwahashi1,
Shinsuke Sakai1, Taku Fujimoto1, Satoshi Minami1, Yoshimasa Fujita1 and
Kenji Yokoyama1
1
Osaka Koseinenkin Hospital, Osaka, Japan
Introduction and Aims: Previous studies have demonstrated that carotid
intima-media thickness (CIMT) is positively associated with mortality. The
relationship between CIMT at the commencement of haemodialysis and short- and
long-term prognosis remains unknown. We conducted a retrospective study to
correlation between CIMT in patients beginning haemodialysis and all-cause mortality
and non-fatal cardiovascular events.
Methods: We retrospectively enrolled 162 patients who started dialysis at our
nephrology department between January 2010 and June 2013. We excluded patients
who selected peritoneal dialysis or kidney transplantation, who did not undergo
carotid artery ultrasound examination within one month after the initiation of dialysis,
or who died within one month after the initiation of dialysis. We measured CIMT with
carotid ultrasound at three points in the common carotid arteries and calculated the
mean CIMT. The end point was all-cause mortality and non-fatal cardiovascular
events. End-point-free survival was calculated by Kaplan Meier analysis and compared
using the log-rank test. We used Cox proportional hazards analysis to determine
independent predictors for end-points among the clinical data at the time of referral to
a nephrologist. ROC analysis was used to determine the best cut-off value of CIMT to
predict the end-points.
Results: The study included 73 participants. Median follow-up period was 18.2 months
(interquartile range, 5.6-28.2 months). Median age was 67 years (interquartile range,
58-74 years), 58.3% were men, 54.4% had diabetes mellitus, and 28.1% had a history of
cardiovascular disease. Twelve patients (16.4%) died during study period, ten (13.8%)
from cardiovascular causes. Eighteen patients (24.7%) experienced non-fatal
cardiovascular events. CIMT was significantly higher among the 30 patients who
reached the end point compared to the 43 patients who did not (0.93 mm vs. 0.81 mm,
P < 0.046). After adjustment for other established predictive factors, CIMT was found
to be the best predictive marker for the end-point (hazard ratio 2.063, 95% CI
1.030-3.124, P = 0.043). The optimal cut-off value of CIMT suggested by ROC analysis
was 0.90 mm. Patients with CIMT above the cut-off point experienced a significantly
poorer outcome than those with CIMT below the cut-off point within 24 months.
CIMT was not a predictor of long-term morbidity or mortality.
Conclusions: We found that CIMT in patients starting haemodialysis was associated
with all-cause mortality and non-fatal cardiovascular events within 24 months. CIMT
was not a significant predictor of long-term morbidity or mortality.
MP467
EFFECT OF CHOLECALCIFEROL REPLACEMENT ON LEFT
VENTRICLE MASS INDEX IN DIALYSIS PATIENTS
Veysel Kidir1, Ibrahim Ersoy1, Atila Altuntas1, Salih Inal1, Abdullah Doğan1 and
Mehmet Tugrul Sezer1
1
Süleyman Demirel University Medical School, Isparta, Turkey
Introduction and Aims: Vitamin D deficiency is commonly seen in dialysis patients.
Vitamin D receptors have been shown in many organs and tissues including
cardiomyocytes, endothelium and vascular smooth muscles. It has been demonstrated
that cholecalciferol replacement decreases left ventricle mass index (LVMI) in dialysis
patients. Our objective in this study is to demonstrate the effect of oral cholecalciferol
replacement on left ventricle mass index in dialysis patients.
Methods: Serum 25- hydroxyvitamin D levels of 43 dialysis patients (22 peritoneal
dialysis and 21 hemodialysis) were reviewed. 25-hydroxyvitamin D level <20 ng/mL
was considered to be vitamin D deficiency. The patients were divided into 2 groups.
The patients who had vitamin D deficiency and who accepted treatment comprised the
treatment group (n=26) and the patients who had vitamin D deficiency and did not
accept treatment comprised the control group (n=17). The treatment group received
oral cholecalciferol (vitamin D3) treatment for a total duration of 6 months with a dose
of 50.000 IU/week for the first 3 months and 10.000 IU/week thereafter. Biochemical
parameters of were reviewed, cardiac parameters and left ventricle mass were measured
with echocardiography for all patients at baseline and 6 months later. LVMI was
measured using Devereux Formula.
Results: Both groups were similar in terms of age, sex, duration and type of dialysis,
body surface area, mean serum 25-hydroxyvitamin D level, serum hemoglobin,
albumin, Ca, P, uric acid, total cholesterol, triglyceride, LDL, HDL and PTH ( p>0.05).
No significant changes were found in the parameters ( p>0.05) except
25-hydroxyvitamin D level after replacement in the treatment group. While no
significant change in LVMI was observed in the treatment group ( p=0.16), a significant
increase in LVMI was observed in the control group ( p=0.001). In the repeated anova
analysis, on the other hand, it was found that the change in LVMI between the groups
was statistically not significant ( p=0.18).
Conclusions: Oral cholecalciferol treatment does not decrease left ventricle mass index
in dialysis patients, however it slows down the progression. A significant increase in
LVMI is observed in the subjects who did not receive cholecalciferol. Further
long-term, randomized controlled studies are needed in this subject.
MP468
SEVERE PULMONARY HYPERTENSION IN A HEMODIALYSIS
PATIENT: CASE REPORT
Hiba Azar1, Dima Chacra1, Georges Dabar1 and Dania Chelala1
1
Hotel Dieu de France University Hospital, Beirut, Lebanon
MP464 Figure 1: Spearman correlations between cardiac index variation and K+ gap
(A), dialysate bicarbonate content (B) and Na+ gap (C).
Volume 29 | Supplement 3 | May 2014
Introduction and Aims: Pulmonary arterial hypertension (PAH) is highly prevalent in
hemodialysis (HD) patients and is associated with a poor prognosis. The pathogenesis
of PAH in HD patients remains unclear with many risk factors including fluid
doi:10.1093/ndt/gfu175 | iii
Abstracts
overload, cardiac dysfunction, arteriovenous fistula, bone mineral disorders and
imbalance between vasoconstrictors and vasodilators. We present a case of severe
PAH associated to a large right sided pleural effusion that partially resolved after
drainage.
Results: This is a 57 years old patient with primary oxalosis leading to ESRD in 2004.
He underwent HD for a year then received kidney transplantation. Unfortunately his
primary disease recurred on the graft and he was back on HD since 2008, with a three
times, four hours weekly schedule. The dialysis sessions were well tolerated and he had
no major complaints besides lumbar and diffuse joint pain. He started losing weight
few months ago, because of anorexia and was treated with oral supplements. He then
started complaining of progressive shortness of breath despite lowering his dry weight.
He was admitted to the hospital: the chest X-ray (CXR) showed a right sided pleural
effusion and a 2D cardiac echocardiography showed preserved systolic and diastolic
cardiac function with moderate PAH of 42 mm Hg. The pleural effusion was drained
and the examination of the fluid revealed a transudate. Of note, his albumin level at
that time was 20g/l. He was discharged after dietary counseling and intensification of
HD. During the following dialysis sessions, he started to present hypotensions
precluding efficient ultrafiltration despite withholding his 3 antihypertensive drugs and
the use of albumin drip during the sessions. A new 2D echocardiography was then
obtained, after a dialysis session, and showed again preserved systolic and diastolic
cardiac function but the PAH progressed to 88 mmHg. Few days later, he was admitted
to the ICU for severe systemic hypotension, hypoxia and drowsiness that necessitated
intubation and pulmonary assistance. The CXR showed recurrence of the pleural
effusion filling the whole right cavity with mediastinal shift; chest tube insertion
drained 3,4 liters of transudate. A third 2D echocardiography performed few hours
laters, revealed a decrease of the PAH to 45 mmHg. A pulmonary artery catheter found
a PAP of 42 mm Hg and a pulmonary capillary wedge pressure at 7 mm Hg.We believe
that there are many intricated causes of severe PAH in our patient. In addition to the
known pathogenic pathways that can apply here, the low albumin level and the high
right atrial pressure favored intracavitary fluid accumulation. Our hypothesis is that at
some point the pressure in the right pulmonary cavity, increased and transmitted to the
major pulmonary vessels, creating a vicious circle that was broken by the placement of
the permanent chest tube.
Conclusions: Massive pleural effusions can have a pathogenic and reversible role in
pulmonary hypetension in hemodialysis patients.
MP469
RIGHT VENTRICULAR DYSFUNCTION IN END STAGE RENAL
DISEASE PATIENTS RECEIVING DIFFERENT DIALYSIS
MODALITIES
Lijun Zhao1, Songmin Huang1, Ting Liang1 and Hong Tang1
1
West China Hospital of Sichuan University, Chengdu, China
Introduction and Aims: While chronic dialysis therapy has been exhibited a high
prevalence of pulmonary hypertension, occurrence of right heart failure during dialysis
treatment is associated with high mortality in patients with pulmonary hypertension.
We investigated right ventricular dysfunction (RVD) in stage 5 CKD patients on
different dialysis modalities and the risk factors of RVD.
Methods: This cross-sectional study included 137 patients with end stage renal disease
(ESRD) on a regular dialysis program who were grouped as follows: continuous
ambulatory peritoneal dialysis (CAPD; n = 37), hemodialysis (HD) with central venous
catheters (CVC; n = 30), and HD with arteriovenous fistula (AVF; n = 70). Tissue
Doppler imaging (TDI) of echocardiography to investigate the right ventricular
function was performed in all patients.
Results: Systolic pulmonary artery pressure (sPAP) was progressively rose from CAPD
patients to HD patients with CVC and AVF. RVD, assessed by TDI MPI, was
significantly impaired in HD patients compared with CAPD patients, particularly in
HD patients with AVF. Interestingly, the prevalence of right ventricular hypertrophy
significantly increased in HD patients compared with CAPD patients, which was more
pronounced in the group of HD patients with AVF. At univariate analysis, sPAP was
positive correlated with MPI (r=0.283,p=0.019) and RV wall thickness (r=0.514,
p<0.001).The multivariate determinants of RVD were Kt/V [odds ratio 0.59, 95%
Nephrology Dialysis Transplantation
confidence interval (CI) 0.17-0.98, p = 0. 041] and sPAP (odds ratio 2.85 per
mmHg,95% CI 1.39-4.37, p = 0. 014) when adjusted for the confounding factors such
as age, BMI and heart rate.
Conclusions: Compared with CAPD patients, patients on HD and particularly those
with an arterioveinous fistula are more frequently found with right ventricular
abnormalities and high sPAP. Kt/V and sPAP may play pivotal roles in the
development of RVD.
MP470
LEFT ATRIUM MECHANICAL FUNCTIONS AND ATRIAL
ELECTROMECHANICAL DELAY TIMES IN END-STAGE
RENAL DISEASE PATIENTS RECEIVING HEMODIALYSIS AND
PERITONEAL DIALYSIS
Kultigin Turkmen1, Levent Demirtas1, Emin M Akbas1, Mutlu Buyuklu1,
Eftal Bakirci1, Ismail Kocyigit2, Ozcan Ozcelik3 and Ibrahim Guney4
1
Erzincan University, Erzincan, Turkey, 2Erciyes University, Kayseri, Turkey, 3Erciyes
University, Erzincan, Turkey, 4Meram Training and Research Hospital, Konya,
Turkey
Introduction and Aims: Left atrium (LA) volumes and mechanical functions
and atrial electromechanical delay (EMD) times were recently considered
independent predictors of atrial fibrillation (AF) in general population. However, in the
literature, there has been no study investigating the relationship between these
parameters in end-stage renal disease (ESRD) patients receiving hemodialysis (HD)
and peritoneal dialysis (PD). The aim of study was to evaluate atrial-EMD times and
LA active-passive emptying volumes and associated risk factors in HD and PD
patients.
Methods: Sixty-two HD and 50 PD patients were enrolled in the study. Standard
and Tissue Doppler Echocardiography performed before mid-week dialysis session for
HD patients and on admission for PD patients. Data were expressed as mean ± SD.
Dichotomous variables were compared using the chi-square test. Statistical
differences between parametric data of two groups were analyzed using the Student’s
t-test. The Mann-Whitney U test was used to determine differences between
non-parametric data. Linear associations between continuous variables were
assessed using the Spearman correlation test. Lineer regression analyses were
undertaken to determine independent associations among LA active emptying volume
and other variables. interatrial time, left intraatrial time, systolic and diastolic blood
pressure, serum calcium,uric acid, low-density lipoprotein levels,
neutrophil-to-lymphocyte ratio were entered into the regression model as independent
variables and LA active emptying volume was entered as a dependent variable. The
backward elimination method was preferred in the stepwise regression analysis and
p>0.1 used as a criterion for elimination in this model. p< 0.05 was considered
significant for all tests.
Results: Interatrial and left intraatrial-EMD intervals were significantly longer in HD
patients compared to PD patients (Table 1). There has been positive correlations
between LA active emptying volume and interatrial time, left intraatrial time, systolic
and diastolic blood pressure, serum calcium, low-density lipoprotein levels,
neutrophil-to-lymphocyte ratio (r: 0.226 p: 0.016, r: 0.284 p: 0.002, r: 0.347 p<0.001, r:
0.351 p<0.001, r:0.370 p<0.001, r:0.199 p:0.035, r: 0.467 p<0.001, respectively) and
negatively correlated with serum uric acid (r:-0.314, p:0.013) in ESRD patients.In lineer
regression analysis, systolic hypertension, serum calcium levels and NLR but not EMD
intervals were found to be independent predictors LA active emptying volume in this
population
Conclusions: This study demonstrated the effects of inflammation (increased NLR),
serum calcium and hypertension on LA mechanical functions in ESRD patients.
Future large scaled prospective studies are needed to determine the exact roles of
prolonged inter and intraatrial-EMD intervals on LA mechanical functions in this
population.
MP470 Table 1
Parameters
Age (years)
Female/Male
BMI (kg/m2)
SBP (mmHg)
DBP (mmHg)
Glucose (mg/dL)
Albumin (g/dL)
Total cholesterol (mg/dL)
LDL- cholesterol (mg/dL)
HDL- cholesterol (mg/dL)
Triglyceride (mg/dL)
Calcium (mg/dL)
Phosphorus (mg/dL)
Left Intraatrial Time (msn)
Right Intraatrial Time (msn)
Interatrial time (msn)
HD patients (n = 62)
62±17
29/33
23.9±1.9
126±20
77±10
111±45
3.5±0.3
165±41
86±29
37±13
213±131
8.1±0.9
5.4±1.6
15.3±10.0
13.0±9.8
28.2±14.9
PD Patients (n = 50)
63±12
18/32
23.8±2.0
135±13
83±9
117±46
2.9±0.4
195±59
118±50
37±10
116±77
9.3±1.0
4.3±1.0
17.8±7.6
12.4±6.0
29.2±9.3
P value
0.94
0.33
0.92
0.004
0.002
0.41
<0.0001
0.001
<0.0001
0.65
0.98
<0.0001
<0.0001
0.018
0.41
0.21
MP469
iii | Abstracts
Volume 29 | Supplement 3 | May 2014
Abstracts
Nephrology Dialysis Transplantation
MP471
THE PREVALENCE OF CARDIORENAL SYNDROME AND ITS
RELATION WITH METABOLIC SYNDROME IN HEMODIALYSIS
PATIENTS
Suela Mumajesi1, Albana Velaj1, Alma Idrizi1, Nevi Pasko1, Vilma Cadri1,
Myftar Barbullushi1, Erjola Bolleku1, Ariana Strakosh1, Anisa Cenaj1, Viola Kacori1,
Ervin Zekollari1, Elvana Rista2, Dritan Dusha2, Ajola Belba1 and Nestor Thereska1
1
University Hospital Mother Teresa, Tirana, Albania, 2Hygeia Hospital, Tirana,
Albania
Introduction and Aims: Purpose: Most of the hemodialysis population suffers from
cardiovascular disease, so cardiorenal syndrome (CRS) which comprising both cardiac
and renal disease is very common among this group of patients. In the other hand
metabolic syndrome (MS) is an important risk factor for both cardiac and renal
dysfunctions. The aim of the study is to evaluate the present of CRS and its relationship
with MS in hemodialysis patients.
Methods: Methods: One hundred twenty three hemodialysis patients of University
Hospital Center were enrolled in the study: 74 patients were males (60.2 %) and 49
patients were females (38.9%). The mean age was 52.63 ± 12.8 years. Years in
hemodialysis 3.7 ± 2.3 years. The CRS was defined in according to the consensus
conference of the Acute Dialysis Quality Initiative .The MS was defined according to
International Diabetes Federation (IDF).
Results: Results: The prevalence of CRS was 82.1% (101 patients). According to type of
SCR we found; type 2 of SCR 0.8% (1 patient), type 3 of SCR 15.4% (19 patients), type
4 of SCR 63.4% (78 patients), type 5 of SCR 2.4% (3 patients). 48.8% were males
patients (60) vs. 33.3% females patients (41) ( p<0.71). The mean age was 44.06 ± 15.21
years, comparing with patients who were not with CRS 54.97 ±11.2 years, ( p<0.01).
Years in hemodialysis for CRS patients was 4.67 ± 2.47 years and for patients without
CRS was 3.5 ± 2.33 years ( p≤0.09).The prevalence of MS according to IDF definition
was 48% (59 patients): 40 were males (32.5%) vs. 19 females’ patients (15.4%)
( p≤0.097). The mean age was 56.98 ± 10.7 years comparing to patients without MS
48.07 ± 13.443 years ( p<0.001). Years in hemodialysis for MS patients was 3.58 ± 2.119
years and for patients without MS was 3.8 ± 2.63 years ( p<0.593).. According to our
study 46.3 % (57 patients) had both CRS and MS vs. 35.8% (44 patients) who had only
CRS ( p<0.0001). From a multivariable analysis, the advanced age (44.6% vs. 54.99,
p<0.01), the presence of arterial hypertension (43.1% vs. 37.4%, p<0.001), diabetes
(16.3% vs. 0.8%, p<0.001), were strongly associated with CRS as well as with MS.
Conclusions: Conclusions: The prevalence of CRS was high in our hemodialysis
population.The most prevalent was type 4 of CRS. We find a strong relationship
between CRS and MS. Hypertension, diabetes and advanced age were significant
factors in both syndromes. Hence, knowing better the relationship between these both
syndromes will help us to upgrade diet modification and drugs combinations to lower
as much as possible the mortality risk in these patients.
MP472
THE ASSOCIATION OF KDIGO SUGGESTIONS FOR MINERAL
AND BONE DISORDER MARKERS ACHIEVEMENT AND
PRESENCE OF THE CARDIAC VALVE CALCIFICATION IN OUR
HEMODIALYSIS PATIENTS
Sasho Gelev1, Slavco Toshev1, Lada Trajceska1, Svetlana Pavleska1,
Gjulsen Selim1, Pavlina Dzekova1 and Aleksandar Shikole1
1
Clinical Center, Skopje, Republic of Macedonia
Introduction and Aims: The aim of this study was to evaluate the association between
the attainment of KDIGO suggestions for mineral and bone disorder (MBD) markers
levels and the cardiac valve calcification presence in our hemodialysis (HD) patients.
Methods: In a cross-sectional study we analyzed 112 patients (68 male; mean age 54.8
±17.3 years) dialyzed on average for 97.4±58.8 months. Baseline echocardiography was
performed on all patients to screen for calcification of the cardiac valves. The patients
ware stratified according to the number of calcified valves in three groups: group I,
those (n-34, 30.47%) without valvular calcification; group II, those (n-47, 41.9%) with
one calcified valve (either mitral or aortic); group III, those (n-31, 27.7%) with
calcification on both valves (mitral and aortic). In addition, the serum levels and the
proportion of the KDIGO guideline achieved ranges for MBD markers of the last 12
months records between the groups of patients were compared.
Results: In total 1244 data for serum calcium (Ca), 1252 data for serum phosphate (P)
and 196 data for serum intact parathyroid hormone (iPTH) were analyzed. There was
no significant difference in any of the serum MBD marker levels between the different
groups of patients. In contrast, the patients without valvular calcification had
significantly higher percentages of attained KDIGO recommended levels for serum Ca
(193/372; 55.2%), serum P (197/376; 52.4%) and serum iPTH (34/58; 58.6%) in
comparison with the other two groups of patients. There were no difference in the
attainment of the recommended levels for serum Ca (157/524; 29.9% vs 93/348;
26.7%), serum P (168/526; 31.9% vs 99/350; 28.3%) and serum iPTH (26/83; 31.3% vs
15/55; 27.3%) between the groups of patients having one and patients with both
calcified valves. Multivariate adjusted logistic regression analyses (with group of the
patients without valvular calcification as the reference value) identified serum P in
KDIGO proposed ranges as a factor independently and significantly associated with the
cardiac valve calcification occurrence [OR=1.24, CI (1.06-1.44), p=0.007 for the group
with one calcified valve / OR=1.65, CI (1.20-2.26), p=0.002 for the group with both
calcified valves] in our HD patients.
Volume 29 | Supplement 3 | May 2014
Conclusions: The proportions of MBD markers achievement within the KDIGO
guidelines might be a superior indicator than serum levels of MBD parameters in the
evaluation of cardiac valve calcification pathogenesis in HD patients. In HD
population, a greater prevention of cardiac valve calcification development could be
managed if a higher proportion of the suggested levels for the serum bone and mineral
markers, especially phosphate are achieved.
MP473
RISK FACTORS FOR CARDIOVASCULAR EVENTS AND
ALL-CAUSE MORTALITY IN DIABETIC HEMODIALYSIS
PATIENTS
Hege Næss1, Bengst Fellstrøm2, Alan G. Jardine3, Roland E Schmieder4,
Faiez Zannad5, Hallvard Holdaas1, Geir Mjøen1 and On Behalf Of The Aurora Study
Group
1
Oslo University Hospital, Oslo, Norway, 2University Hospital Uppsala, Uppsala,
Sweden, 3University of Glasgow, Glasgow, United Kingdom, 4University Hospital
Erlangen, Erlangen, Germany, 5Nancy University, Nancy, France
Introduction and Aims: There are uncertainties regarding risk factors in diabetic
hemodialysis patients. We assessed possible associations in a post hoc analysis of the
AURORA trial.
Methods: AURORA was a randomized, double-blind, placebo-controlled study to
investigate the effect of rosuvastatin on cardiovascular outcomes and mortality in
hemodialysis patients. We investigated potential risk factors at baseline for all-cause
mortality, cardiac events and MACE using Cox regression.
Results: In total, 731 patients with median age of 65 years, at baseline were available for
analysis. Median time on dialysis was 1.7 years. During a median follow-up of 3.6
years, there were 432 deaths. In multivariate analysis, all-cause mortality was
significantly associated with age (HR 1.02, CI 1.01-1.04), albumin (HR 0.96, CI
0.93-0.99) and hsCRP (HR 1.26, CI 1.11-1.32). Cardiac events were associated with
phosphate (HR 1.34, CI 1.02-1.75), albumin (HR 0.95, CI 0.90-0.99) and hsCRP (HR
1.15, CI 1.00-1.31). MACE was significantly associated with age (HR 1.02, CI
1.00-1.04), smoking (HR 1.47, CI 1.02-2.12), phosphate (HR 1.43, CI 1.14-1.78),
albumin (HR 0.95, CI 0.91-0.98), hsCRP (HR 1.18, CI 1.05-1.32) and hemoglobin (HR
1.01, CI 1.00-1.02). Body mass index, gender, LDL-cholesterol, blood pressure, dialysis
vintage and Kt/V were not associated with outcomes.
Conclusions: Non-traditional cardiovascular risk factors are predominant in diabetic
hemodialysis patients.
MP474
CAROTID−INTIMA MEDIA THICKNESS PREDICTS OUTCOME
IN CHRONIC KIDNEY DISEASE
Koichi Sasaki1, Satoshi Yamguchi1, Atsushi Hesaka1, Eriko Iwahashi1,
Shinsuke Sakai1, Taku Fujimoto1, Satoshi Minami1, Yoshimasa Fujita1 and
Kenji Yokoyama1
1
Osaka Koseinenkin Hospital, Osaka, Japan
Introduction and Aims: In addition to its role as a marker of systemic atherosclerosis,
carotid intima-media thickness (CIMT) is also a marker of vascular endothelial
dysfunction. However, the impact of CIMT in patients with chronic kidney disease
(CKD), remains unclear. We conducted a retrospective study to evaluate the role of
CIMT as a predictive marker of the prognosis of CKD.
Methods: We retrospectively enrolled 192 patients with recent-onset CKD stage 4 or 5
at department of nephrology between March 2008 and December 2012. The patients
were not on dialysis. We excluded patients who did not undergo carotid artery
ultrasound examination within three months after the first visit, or who required
dialysis within three months from first visit were excluded. The endpoint was end-stage
renal disease (ESRD) requiring dialysis. End point-free survival was calculated by
Kaplan-Meier analysis and compared using the log-rank test. We used Cox
proportional hazards analysis to determine independent predictors for renal outcome
among the clinical data at the time of referral to a nephrologist. ROC analysis was used
to determine the best cut-off value of CIMT to predict the need for dialysis.
Results: The study included 101 participants. Median follow-up period was 18.7
months (interquartile range, 7.8-23.2 months). Among the 101 subjects, median age
was 66 years (interquartile range, 56-76 years), 63.4% were men, 58.3% had diabetes
mellitus, and 30.2% had a history of cardiovascular disease. Median creatinine level
3.45 mg/dl (interquartile range, 2.39-4.55 mg/dl). During the study period, 66 (65.3%)
patients went on dialysis. CIMT was significantly higher among these 66 patients in the
35 patients who did not require dialysis (0.97 mm vs. 0.82 mm, P < 0.049). After
adjustment for other established predictive factors of renal outcome, CIMT was found
to be the best predictive marker for the end point (hazard ratio 2.343, 95% CI
1.080-5.080, P = 0.031). The optimal cut-off value of CIMT suggested by ROC analysis
was 0.98mm. Patients with CIMT above the cut-off point experienced a significantly
poorer renal outcome than those with CIMT below the cut-off point.
Conclusions: Our findings suggest that CIMT is a useful predictive marker of
progression to ESRD in CKD.
doi:10.1093/ndt/gfu175 | iii
Abstracts
MP475
FACTORS INFLUENCING ARTERIAL STIFFNESS IN
HEMODIALYSIS PATIENTS AND KIDNEY TRANSPLANT
RECIPIENTS
Olga Bilevich1, Svetlana Bunova1 and Sergei Semchenko2
1
The State Educational Institution of Higher Professional Training «Omsk State
Medical Academy», Omsk, Russian Federation, 2Kabanov Omsk City Clinical
Hospital &#8470; 1, Omsk, Russian Federation
Introduction and Aims: Identification of arterial stiffness as a cardiovascular risk
factor associated with uremia and renal replacement therapy (RRT) has important
prognostic value in patients with end stage renal disease (ESRD). Since, to date, every
second of these patients die from cardiovascular events. So far, there are a limited
number of studies on the elastic properties of the arteries in patients undergoing
different types of RRT. This study was conducted to determine the factors influencing
arterial stiffness in patients on hemodialysis and kidney transplant recipients.
Methods: In an open prospective randomized study included 75 ESRD patients (42 M/
33 F; age 49 ± 14) receiving renal replacement therapy - of which 58 were on
hemodialysis, 17 had a functioning kidney transplant. To assess arterial stiffness index
used PWV calculated by contour analysis of peripheral pulse wave recorded by
fotopletizmografic instrument Pulse Trace PCA 2000 (MicroMedical Ltd., United
Kingdom).
Results: Аrterial stiffness did not differ between groups examinees: PWV in
hemodialysis patients was 9.3 ( 8.2; 10.7 ) m/s in patients after kidney transplantation
9,3 ± 2,0 m/s ( p = 0.887981). In conducting the correlation analysis in the group of
hemodialysis patients no association was found between PWV and age of patients,
duration of hemodialysis and hypertension, hemoglobin and total cholesterol levels.
However, we revealed that PWV is a negative correlation of medium strength with
body mass index (BMI) (r = -0,31, p = 0.016811). In the group of kidney transplant
recipients correlation analysis showed that PWV correlated with the age of patients (r =
0,65; p = 0.004995 ) and total cholesterol level (r = 0,51; p = 0.0376330 ) and found no
connection with duration of the RRT and hypertension, hemoglobin and creatinine
levels.
Conclusions: We did not find significant differences between the values of PWV in
hemodialysis patients and kidney transplant recipients. In dialysis patients with low
BMI appeared determinant of arterial stiffness. For kidney transplant recipients arterial
stiffness is associated with traditional cardiovascular risk factors - such as age and total
cholesterol.
MP476
OVERHYDRATION IN HEMODIALYZED PATIENTS LEADS TO
AN INCREASED CARDIOVASCULAR BURDEN AND POOR
PROGNOSIS
Krzysztof Schwermer1, Krzysztof Hoppe1, Patrycja Klysz1, Ewa Baum1,
Dorota Sikorska1, Dorota Radziszewska1, Peter Sawatiuk1, Paweł Olejniczak1,
Krzysztof Pawlaczyk1,2, Bengt Lindholm2 and Andrzej Oko1
1
Poznan University of Medical Sciences, Poznan, Poland, 2Karolinska Institutet,
Stockholm, Sweden
Introduction and Aims: Chronic overhydration (OH) and arterial hypertension (HT)
are observed quite regularly in patients suffering from end-stage renal disease (ESRD)
undergoing hemodialysis (HD). Both of them have a strong influence on
cardiovascular system efficiency, leading to slow and gradual damage. The use of
electric bioimpedance spectroscopy (BIS) offers the possibility to monitor fluid
overload in a simple and quantifiable way. The purpose of this study was to evaluate
the impact of OH, HT, and their coincidence on patients’ cardiovascular condition and
survival prognosis.
Methods: This observational study was carried out in a group of 225 HD patients (153
males, mean age 62.5±16.2 years, and 72 females, 63.4±14.5 years). BIS was employed
to estimate the overhydration level (OH) as well as the fatty and lean tissue indices
(FTI, LTI), N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac
troponin T (cTnT) were used as markers of cardiac damage and mortality prognosis.
Additional tests included inter alia hemoglobin (Hgb) and albumin (Alb) levels.
Subsequently to a single observation point, the studied group was followed-up for a
mean time of 27.5 months. The entire cohort has been divided with regard to the
presence of HT (MBP>106.7 mmHg) and relative OH (OH/body weight≥3.0%) into 4
subgroups: nonHT-nonOH (n=86, mean age 64.5±15.0), nonHT-OH (n=71, 63.4
±15.6), HT-nonOH (n=35, 58.7±15.2), HT-OH (n=33, 61.2±17.5).
Results: The highest mortality rates (%) were observed in both hypervolemic groups
(nonHT-nonOH/nonHT-OH/HT-nonOH/HT-OH: 11.6/23.9/5.7/24.2%, p<0.05).
These groups were also characterized by the highest serum concentrations of
NT-proBNP (8818±11770/18263±13583/ 8129±9570/19980±13974 pg/ml, p<0.00001)
and cTnT (0.066±0.064/0.117±0.129/0.058±0.109/ 0.102±0.083 ng/ml, p<0.00001), as
well as the lowest levels of Alb (4.56±3.60/3.80±0.52/ 4.29±0.39/3.87±0.51 g/dl,
p<0.00001). Hgb level and BMI were the lowest in nonHT-OH group (11.4±1.6/10.4
±1.3/11.5±1.7/10.9±2.0 g/dl, p<0.001; 27.2±5.8/24.7±3.9/27.9±4.7/25.1±4.7, p<0.001,
respectively) whereas residual daily diuresis and FTI were found the lowest in HT-OH
group (992±757/767±662/1173±881/525±609 ml, p<0.01; 15.2±6.2/11.5±3.9/14.2±5.7/
11.0±5.3, p<0.00001, respectively). No significant differences were found when
comparing HD efficacy assessed with spKt/V (1.23±0.25/1.15±0.33/1.22±0.18/1.27
±0.32). We also observed several strong correlations between OH and: NT-proBNP
iii | Abstracts
Nephrology Dialysis Transplantation
(r=0.44, p<0.00001), cTnT (r=0.38, p<0.00001), Alb (r=-0.33, p<0.00001).
Conclusions: The presence of overhydration seems to be associated with an increased
cardiovascular burden reflected by high NT-proBNP and cTnT levels, which ultimately
leads to increased mortality in the group of affected patients. Surprisingly, the
coincidence of OH and HT does not seem to have any additional negative effect on
patients’ prognosis. Due to a relatively small group and short follow-up time in this
study, further research in this matter is necessary.
MP477
TOPOGRAPHY OF THE CORONARY TREE CALCIFICATIONS
IN CHRONIC HEMODIALYSIS
Mohamed El Amrani1, Mohamed Asserraji2, Aziz Rbaibi2, Ahmed El Kharass2 and
Mohammed Benyahia1
1
Military Teaching Hospital Mohammed V, Rabat, Morocco, 2First Medical and
Surgical Center, Agadir, Morocco
Introduction and Aims: Cardiovascular disease is the first leading cause of death in
hemodialysis. On these patients, cardiovascular calcifications occur at an earlier age
and are developing faster than in the general population.
Methods: Forty-nine patients on chronic hemodialysis, 26 men and 23 women , mean
age 56.4 years , with an mean duration of 85 months on hemodialysis underwent
screening for coronary calcification (CC) by a 64 slide cardioscanner with ECG
synchronization and without contrast injection. CC were studied at the anterior inter
ventricular artery (AIV) , the right coronary artery (RCA) , the left coronary artery
(LCA) , the circumflex artery (Cx) , the diagonal artery (Diag) and the posterior inter
ventricular artery (PIA) . Agatston coronary calcium score (ACCS) was calculated by a
pre supplied software.
Results: Coronary calcifications concerned 69.4 % of cases and were distributed as
follows: 69.4% AIV, RCA 36.7%, 32.7% Cx, Diag 29.6% 20.4% LCA, PIA 8.2%. CC sat
in one artery in 22.4 % of cases, in 2, 3 or 5 arteries in 10.2% of cases, respectively, in 4
arteries in 14.3 % of cases and at 6 divisions in one patient. The mean ACCS was 331.1,
and 522.2 in the 10 patients treated for ischemic heart disease ( p = 0.09). The mean
ACCS by coronary division was: AIV 88.5, 69.8 CX, RCA 46.6, 15.8 Diag , LCA 6, PIA
2.8 . Coronary calcifications were significantly associated with conventional
cardiovascular risk factors (age, male sex, systolic blood pressure, diabetes, history of
ischemic heart disease).
Conclusions: In this study, the topography of CC is superimposable to coronary
atherosclerosis with which CC share several risk factors. Autopsy studies confirm that
CC in patients with renal failure are more intense and are associated with more
complex histological alterations in comparison with general population. Other studies
confirm that total and individual coronary artery calcium scores are independent
predictors of mortality in hemodialysis patients. Our results confirm the high
prevalence of CC in hemodialysis and encourage early and regular screening.
MP478
SEVERITY OF LEFT VENTRICULAR HYPERTROPHY AND
CARDIOVASCULAR MORTALITY IN END-STAGE RENAL
FAILURE PATIENTS UNDERGOING PERITONEAL DIALYSIS
AND HEMODIALYSIS
Merita Rroji ( Molla)1, Saimir Seferi1, Majlinda Cafka1, Nereida Spahia1, Erjola Likaj1,
Nestor Thereska1 and Myftar Barbullushi1
1
University Hospital Center "Mother Teresa", Tirana, Albania
Introduction and Aims: Cardiovascular disease is a major cause of death in dialysis
patients, accounting over 40% of the mortality and is considerably higher than that of
the general population.The aim of this study was to evaluate the prevalence of
ventricular geometry and the mortality of patients with end stage renal disease on
peritoneal and hemodialysis treatment.
Methods: A case control study was conducted from January 2011 - December 2012,
enrolling all patients on chronic dialysis (HD and PD) older than 18 years who had
more than 3 months in therapy. Two-dimensional echocardiography was performed by
a single experienced cardiologist who was blinded to all clinical details of patients. The
echocardiography was performed 2-24 h after the dialysis session, and the
measurements of diameters and volumes were done according to AEE
recommendation.
Results: Our dialysis population studied consisted in 122 pts, 78 pts (61%) on
hemodialysis, mean age 53.4±14.5 years and mean time on therapy was of 40.4 ± 14.4
months. PD pt were older and have lower time in therapy. Concentric hypertrophy was
found in 42.3% of HD pts and in 61.4% of PD pts ( p=0.058) wheras eccentric
hypertrophy in 43% of HD pts and in 29.5% of pts in PD ( p>0.07). There were
significantly increasing pulse pressure and higher CRP across the three groups with
increasing LVM-i. Pulse pressure was found the only indipendent rrisk factor
associated with LVM-i [1.04 (0.99-1.09) p<0.05].Cardiovascular mortality during
follow up was 15.5% (19 events). It was not found significant difference in KV
mortality in patients on PD and HD, [log rank Mantel- Cox ( p=0.364)]. The main
causes of CV death were sudden deaths (31.5%), deaths from ischemic heart disease
and stroke with 26.4% respectively. Binary logistic regression analysis showed that CRP
[OR= 1.06 (1.01-1.10) p=0.011], CaxP product [OR1.11 (1.01-1.22) p=0.033 and
LVM-i [OR=1.03 (0.68-0.98) p=0.029] were independent risk factors for cardiovascular
mortality in dialysis patients.
Volume 29 | Supplement 3 | May 2014
Abstracts
Nephrology Dialysis Transplantation
Conclusions: We didn’t found significant diference in ventricular geometry and CV
mortality between two dialysis modalities. Concentric hypertrophy is the most frequent
left ventricular geometry in patients treated with PD. LVH, inflamation, CaxP product
and PP are interrelated and combine adversely to increase mortality and cardiovascular
death risk of dialysis patients.
MP479
EFFECTS OF PERDIALYTIC CYCLING ON THE PERIPHERAL
MICROCIRCULATION IN CHRONIC HEMODIALYSIS
PATIENTS: PRELIMINARY RESULTS OF ACTIVDIAL STUDY
Caroline C Pelletier1,2, Anne Jolivot1, Emilie Kalbacher1,2, Marine Panaye1,
Pascale Bureau Du Colombier1 and Laurent Juillard1,2
1
Hospices Civils de Lyon, Lyon, France, 2Université de Lyon, Villeurbanne, France
Introduction and Aims: Chronic kidney failure is associated with a high prevalence of
peripheral arterial diseases (PAD). Due to the impairment of the peripheral cutaneous
perfusion, PAD lead to wounds, infections then amputations or death. Currently,
medical therapies are limited to the stabilization of PAD lesions. Moreover, due to the
established reduced activity in chronic hemodialysis patients, the impact of exercise
and lower extremity rehabilitation for PAD is limited. However, many studies have
shown clinical benefits of a perdialytic physical activity. To date, no data reports the
effects of a perdialytic activity on the leg skin perfusion. The aim of this pilot
prospective study is to investigate the impact on the microcirculation of a three-month
perdialytic cycling period with the Letto bike (MOTOmed®).
Methods: Cycling was performed at each dialysis session, for 30 minutes, 3 times a
week. Patients are free to choose the resistance magnitude. The primary outcome is the
increase of the cutaneous perfusion, assessed by measuring transcutaneous oxygen
pressure (TcPO2). The secondary outcomes are clinical outcomes: evolution of blood
pressure, heart rate, systolic pressure index, handgrip test, pedometer measurement,
quality of life and biological parameters (nutrition, inflammation and CKD associated
bone mineral disorders).
Results: Perdialytic cycling was performed in 11 chronic hemodialysis patients. All of
them actively cycled with a good clinical tolerance. Peripheral perfusion was
unchanged before and after perdialytic cycling (TcPO2: 63.7±13.6 before and 57.7
±12.4 mmHg after; p=0.119 for the left legs and 58.4±16.0 before and60.1±10.6 mmHg
after; p=0.919 for the right legs).In contrast, results of secondary clinical outcomes tend
to confirm published data, such as a decrease of systolic blood pressure and heart rate.
Moreover, results of biological assessments show an improvement of plasma calcium
(2.13±0.15 before and 2.20±0.14 mmol/L after; p=0.068) and a significant increase of
bone alkaline phosphatase (19.6±15.4 before and 27.1±21.0 μg/L after; p=0.018).
Conclusions: Our preliminary results demonstrate a significant increase of bone
alkaline phosphatase associated with an increase of plasma calcium after 3 months
perdialytic cycling without significant change on microcirculation. These results
suggest a potential beneficial effect of perdialytic cycling on bone mineral disorders.
MP480
BLOOD PRESSURE PROFILE IN CHRONIC HAEMODIALYSIS
PATIENTS - BASELINE DATA FROM THE CORDIAL
(CARDIOVASCULAR OUTCOMES REGISTRY IN DIALYSIS)
STUDY
Jayme E. Burmeister1, Camila B. Mosmann1, Juliano P. Bastos1, Bruna
O. Burmeister1, Gisiane Munaro1, Japao D. Pereira2, Debora Wassaf Youssef1 and
Guido A. Rosito1,2
1
Universidade Luterana do Brasil, Canoas, Brazil, 2Universidade Federal de
Ciencias da Saude de Porto Alegre, Porto Alegre, Brazil
Introduction and Aims: Hypertension is highy prevalent and is an important
cardiovascular risk factor among dialysis patients. We conducted an analysis of the
profile of BP in a cohort of haemodialysis (HD) patients in a Brazilian metropolitan
city - the CORDIAL Study, designed to evaluate and follow cardiovascular data.
Methods: All 1,215 adult patients in haemodialysis for chronic renal disease in the 15
dialysis units in Porto Alegre (Brazil) in 2010-2011 were considered for inclusion. Data
for blood pressure (BP) - pre and post-dialysis, and in days off-dialysis - were obtained
from registries of the CORDIAL Study, being available for 1200 individuals.
Hypertension was defined as a pre-dialysis systolic and/or diastolic BP respectively of
≥140 and ≥90 mmHg, or the use of any antihypertensive drug. Control of
hypertension was defined as pre-dialysis BP <140/90mmHg and post-dialysis <130/
80mmHg. For all purposes, we considered an average of the last 3 measurements of
pre- and post-dialysis BP from the dialysis individual charts. As concernig to BP in
days off-dialysis, we considered an average of 3 or more values obtained in periodic
medical appointments in the last 2 months.
Results: The mean age was 52.7±11.6 yrs-old, and 60.9% were males. The prevalence of
hypertension in these 1200 patients was 87.4%, and only 20.3% of the hypertensive
individuals had BP controlled values. Only around 16% of patients with uncontrolled
pre-dialysis BP end dialysis with controlled BP (<130/80mmHg); in off-dialysis days,
only 18% had controlled BP (<140/90mmHg).Prevalence of pulse pressure (PP) ≥
60mmHg was significantly higher in non-controlled when compared to controlled or
to non-hypertensive patients in the three situations ( pre-, post-, and off-dialysis) p<0.0001 (Chi-square) for all.
Conclusions: Prevalence of uncontrolled hypertension was high in this cohort, either
for pre- and post-dialysis as during off-dialysis days. At least two thirds of hypertensive
patients presented PP persistently over 60mmHg.
MP479
MP479
Volume 29 | Supplement 3 | May 2014
doi:10.1093/ndt/gfu175 | iii
Abstracts
Nephrology Dialysis Transplantation
MP480
Non-hypertensive(n=151)
Hypertensive(n=1049)
Not controlled(n=836)
Controlled(n=213)
Pre-dialysis arterial blood pressure
Systolic (mmHg) - mean±SD
Diastolic (mmHg) - mean±SD
Systolic ≥140 and/or diastolic ≥90mmHg - (%)
Pulse pressure (mmHg) - mean±SD
Pulse pressure ≥60mmHg - (%)
157.8±18.0
87.1±13.1
100
71.0±18.1
84.8
121.8±11.1
72.7±9.6
Post-dialysis arterial blood pressure
Systolic (mmHg) - mean±SD
Diastolic (mmHg) - mean±SD
Systolic ≥130 and/or diastolic ≥80mmHg - (%)
Pulse pressure (mmHg) - mean±SD
Pulse pressure ≥60mmHg - (%)
142.1±22.8
80.1±12.6
83.6
62.0±18.8
59.7
124.0±17.6
71.2±10.5
Out-of-dialysis arterial blood pressure
Systolic (mmHg) - mean±SD
Diastolic (mmHg) - mean±SD
Systolic ≥140 and/or diastolic ≥90mmHg - (%)
Pulse pressure (mmHg) - mean±SD
Pulse pressure ≥60mmHg - (%)
152.8±24.2
87.0±14.2
82.2
65.8±20.1
71.7
132.0±20.6
79.5±11.7
35.8
52.5±15.7
36.4
iii | Abstracts
49.5±12.4
23.5
52.1±15.8
34.7
p
122.4±15.4
72.9±10.8
<0.0001 - CI95%:18.921-24.079 (t-test)
<0.0001 (Chi-square)
49.5±11.4
31.1
117.7±19.4
70.1±10.7
<0.0001 - CI95%:7.151-12.649 (t-test)
<0.0001 (Chi-square)
49.5±18.8
18.5
118.5±14.0
75.0±10.3
<0.0001 - CI95%:10.391-16.209 (t-test)
<0.0001 (Chi-square)
43.5±11.6
17.2
Volume 29 | Supplement 3 | May 2014