Abstract: FR-OR048

Changes in Biomarker Profile and Left Ventricular Hypertrophy Regression: Results from the Frequent Hemodialysis Network Trials

Session Information

  • Home Hemodialysis
    November 03, 2017 | Location: Room 295, Morial Convention Center
    Abstract Time: 04:30 PM - 04:42 PM

Category: Dialysis

  • 604 Home and Frequent Dialysis

Authors

  • Chan, Christopher T., Toronto General Hospital, Toronto, Ontario, Canada
  • Kaysen, George A., UC Davis, Davis, California, United States
  • Beck, Gerald J., Cleveland Clinic Foundation, Cleveland, Ohio, United States
  • Li, Minwei, Cleveland Clinic Foundation, Cleveland, Ohio, United States
  • Lo, Joan C, Kaiser Permanente Northern California, Oakland, California, United States
  • Rocco, Michael V., Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
  • Kliger, Alan S., Yale New Haven Health System, New Haven, Connecticut, United States
  • Trial Group, The FHN, NIDDK, NIH, Bethesda, Maryland, United States

Group or Team Name

  • FHN Trials Group
Background

Regression of left ventricular hypertrophy (LVH) has been shown to be feasible with more frequent hemodialysis. We aimed to ascertain potential biological pathways associated with regression of left ventricular mass (LVM) in patients enrolled in the Frequent Hemodialysis Network (FHN) Trials.

Methods

FHN participants were stratified according to LVM response. Regressors were defined as patients who achieved a reduction of more than 10% in LVM at 12 months. Progressors were defined as patients who had a minimum of 10% increase in LVM at 12 months.

Results


Among 332 randomized patients, there were 77 regressors and 45 progressors. LVM change differed between the 2 groups by -65.6(-74.0, -57.2) g, p < 0.001). Regressors had a median increase in dialysis frequency (from 3 (3,3) to 4.9 (3, 5.7) per week, p = 0.001) and median reductions in pre-dialysis systolic (from 149 (136, 162) to 136 (123, 152) mmHg, p <0.001) and diastolic (from 83 (71, 91) to 76 (68, 84) mmHg, p<0.001) BP. Amongst the various pre-defined cardiac biomarkers, Klotho levels increased significantly in patients with LVM regression versus those who had LVM progression (76.9 (10.5; 143.3) pg/ml, p = 0.024). Similarly, tissue inhibitors of metalloproteinase - 2 (TIMP – 2) levels fell in patients who had LVM regression than in the progressors (-7853 (-14653; -1052) pg/ml, p = 0.024). TIMP – 1 and LogBNP levels also tended to fall in patients with LVM regression. Changes in LVM correlated inversely with changes in Klotho (r = -0.24, p = 0.014). Amongst patients with LVH at baseline, copeptin tended to differ between progressors and regressors (-87.2 (-178.8; 4.4) pmol/L, p =0.06).

Conclusion

Our results demonstrated that markers of collagen turnover and changes in klotho levels are novel pathways, which may provide mechanistic insights into the regression of LVH in dialysis patients.

Funding

  • NIDDK Support