Abstract: SA-PO842

Inflammatory and Angiogenic Factors Associated with Microvascular Changes over a 6-Month Period in a Cohort of Hemodialysis Patients

Session Information

Category: Dialysis

  • 606 Dialysis: Epidemiology, Outcomes, Clinical Trials - Cardiovascular

Authors

  • Mitsides, Nicos, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
  • Cornelis, Tom, Jessa General Hospital, Hasselt, Belgium
  • Broers, Natascha, Maastricht University Medical Centre , Maastricht, Netherlands
  • Diederen, Nanda, Maastricht University Medical Centre , Maastricht, Netherlands
  • Brenchley, Paul E., Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
  • van der Sande, Frank, Maastricht University Medical Centre , Maastricht, Netherlands
  • Schalkwijk, Casper, Maastricht University Medical Centre , Maastricht, Netherlands
  • Kooman, Jeroen, Maastricht University Medical Centre , Maastricht, Netherlands
  • Mitra, Sandip, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
Background

Cardiovascular (CV) disease is a major contributor to poor outcomes in haemodialysis (HD). Comorbidity & oxidative stress are confounding factors to this phenomenon. High Dose HD (HDHD) regimes have been linked with a CV benefit compared to Conventional HD (CHD). We investigate the relationship between HD intensity, pro-inflammatory & endothelial mediators and micro- & macrocirculatory parameters over a 6-month period.

Methods

We report the findings of the 6-month analysis of participants to the study of Uremic Toxins, Cardiovascular Effects & Physical Activity in Intensive Haemodialysis (INTHEMO); a 2yr multicentre study investigating the effects of HDHD on CV parameters. Macrocirculation was assessed with pulse wave velocity & 24hr ambulatory blood pressure measurements. Microcirculation was assessed using sublingual dark field capillaroscopy. A panel of pro-inflammatory & endothelial biomarkers added to the assessment of vascular health. Hydration state was assessed by means of multifrequency bio-impedance.

Results

Of the 47 followed up at over a 6-month period, 21 were performing HDHD (>12hr of haemodialysis per week) & 26 CHD. CHD participant were older (63.5±14.2 v 53.7±12.6yr; p=0.02), with a smaller dialysis vintage (median vintage 23, max-min 6-106 v 61, max-min 10-432 months; p<0.01) & better-preserved residual renal function (61.5% v 9.5%;p<0.01). HD intensity did not correlate to any changes to CV measurements over a 6-month period. Higher serum levels of IL 8 (median 14.3pg/ml, min-max 3.5-185.7) measured at baseline independently predicted increase in the Perfused Boundary Region (5-25μm) of the endothelial glycocalyx (β=0.408, p<0.01) while higher levels of soluble Flt-1 (median 253pg/ml, min-max 139-1434) had a significant inverse effect (β=0.408, p<0.01) in an adjusted multivariate linear regression model.

Conclusion

HD intensity did not predict any changes in either macro- or microvascular parameters in HD patients. Micro-inflammation mediated through the TNF-alpha & IL-8 pathway was a predictor of microvascular injury while Flt-1, a potential marker of angiogenesis & endothelial repair might have a significant protective role. Further exploration into the pathophysiological effects of these pathways is required.

Funding

  • Clinical Revenue Support