Kidney Week

Abstract: TH-PO419

Pilot Study to Determine Whether Cooled Peritoneal Dialysis Confers Cardioprotective Effect

Session Information

• Dialysis: Peritoneal Dialysis - I
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 703 Dialysis: Peritoneal Dialysis

Authors

• Ratner, Shemer, London Health Sciences Centre, London, Ontario, Canada

Shemer Ratner,

• So, Aaron, Lawson Health Research Institute, London, Ontario, Canada

Aaron So,

• Tamasi, Tanya, London Health Sciences Centre, London, Ontario, Canada

Tanya Tamasi,

• McIntyre, Christopher W., London Health Sciences Centre, London, Ontario, Canada

Christopher W. McIntyre,

Background

Despite lack of dialysis induced ischema (characteristic of hemodialysis), patients receiving peritoneal dialysis (PD) also suffer excess cardiac morbidity and mortality- driven by high rates of heart failure and sudden cardiac death. Currently there are no effective primary prevention therapies. Moderate hypothermia is well established in animal models to provide protection against demand ischemia. Furthermore, perfusion heterogeneity disrupts the passage of myocardial depolarization increasing the risk of ventricular re-entrant circuits. The aim of this study was to explore PD as a method of delivering a cooling intervention and test whether or not it could reduce segmental or global stress induced cardiac ischemia.

Methods

We studied 6 patients at 2 study visits. Myocardial perfusion was measured using high resolution 256 slice CT scanning at rest and with adenosine stress. The first visit was done on patients' usual PD regimen, second visit utilised peritoneal dialyzate cooled to 32-33 ⁰ C, to reduce body temperature by 0.5 ⁰ C. Myocardial Perfusion was assessed using the American Heart Association segmentation model with ANOVA test, and perfusion pattern heterogeneity was measured by standard deviation of segmental perfusion.

Results

Cooled dialysate was tolerated well by all patients. No symptoms of cold or drain pain were reported. Cooling significantly decreased rest and trended towards decreased stress global and segmental cardiac perfusion (mean values being 75.53 to 165.83 mL/min/100g). Pharmacological stress was associated with an increase in perfusion heterogeneity (mean increase in SD from 10.87 to 21.09). However, cooling the dialysate significantly reduced this effect by 25%.

Conclusion

Moderate hypothermia can be safely delivered using PD. It provides significant reduction in a potential key risk factor for cardiac sudden death and warrants further investigation to reduce cardiovascular attrition in PD patients.