Abstract: SA-PO686

Cardiovascular Assessment in Patients on Nxstage System One (NxO)

Session Information

Category: Dialysis

  • 604 Home and Frequent Dialysis

Authors

  • Brunati, Chiara Carla Maria, ASST Niguarda, Milano, Italy
  • Gervasi, Francesca, University of Milan Bicocca, Milan, Italy
  • Casati, Costanza, University of Milan Bicocca, Milan, Italy
  • Colussi, Giacomo, ASST Niguarda, Milano, Italy
Background

Left ventricular hypertrophy (LVH) is an independent risk factor for mortality in patients on conventional hemodialysis (HD). According to the Frequent Haemodialysis Network daily trial, increased frequency of conventional in-centre HD is associated with a reduction in antihypertensive therapy, extracellular fluid (ECW) and left ventricular mass. Little data exists with the non-conventional daily dialysis system, NxO.

Methods

From May 2011 to December 2016, we enrolled 12 patients (median age 49yrs, from 25yrs - 66yrs) on a NxO home program, follow up of 22 months (variation 3 to 68months, 6runs a week, QD 22±4L, duration of session 144±25min StKt/V 2,4±0,2). Treatment effects of volume parameters were evaluated monthly in all patients in the interdialytic period, according to BIA parameters (BIA impedentiometry Frisenius) including the proBNP levels. In 6 patients with 12 months of follow up, an echocardiography was also performed in order to evaluate the cardiac mass and compare with data at baseline. We compared BIA evaluation, measurements of the cava diameter and of the presence of lung comets in NxO patients, a total 134 tests, with those of 30 patients on traditional HDB treatment who were evaluated directly post session, as normohydratate. ProBNP was evaluated in both groups.

Results

We observed a reduction of mean blood pressure (from 97±17 to 81±5mmHg) and this even despite a reduction in antihypertensive drug units (median of – 2UD from 0 to – 15UD). In 7 patients with 12 months of follow up, a significant reduction in cardiac mass was recorded (148±44 gr/m2 to 120±35gr/m2 p≤0.05). The BIA evaluation evidences an overhydratation state in only 10% of measurements. In comparison with normohydratate HBD patients, no difference in ECW/TBW values were recorded. NxO patients had higher levels of ICW/TBW values, indicating a more physiological distribution of volume as reflected by lower levels of proBNP.

Conclusion

According to our results, daily HD sessions using NxO improves certain cardiovascular parameters. Although no reduction in extra-cellular volume was seen, we can hypothesize excellent volume control due to the interdialytic measurements.

 Nr pzNr testsSBP (mmHg)MBP (mmHg)ECW/TBWICW/TBWproBNP (ng/L)
HDB3030133 ± 2094 ± 110.45 ± 0.0030.54 ± 0.0308508 ± 11579
NXT12134117 ± 1882 ± 210.45 ± 0.0380.56 ± 0.0342591 ± 4068
p  ≤ 0.001n.s.n.s.≤ 0.005≤ 0.001