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Abstract: FR-OR005

Effect of Intensive Home Hemodialysis on Right Ventricular Systolic Pressure and Clinical Outcomes

Session Information

Category: Dialysis

  • 702 Dialysis: Home Hemodialysis

Authors

  • Girsberger, Michael Yannik, Toronto General Hospital, Toronto, Ontario, Canada
  • Chan, Christopher T., Toronto General Hospital, Toronto, Ontario, Canada
Background

Increased right ventricular systolic pressure (RVSP) is a marker of pulmonary hypertension in patients with end-stage kidney disease (ESKD). Our primary aim is to examine whether nocturnal home hemodialysis (NHD) will modify RVSP in ESKD patients. Our secondary aim is to ascertain the clinical consequence of normalization of RVSP.

Methods

We conducted a retrospective single center cohort study at the Toronto General Hospital including all patients between 1999 and 2017 with baseline and follow-up echocardiograms on intensive home hemodialysis followed for at least 1 year. Patients were categorized according to RVSP response at the end of follow-up: non-responders with increased RVSP and responders with normal RVSP. Multivariate and cox regression analysis were used to identify risk factors for increased RSVP and reaching clinical composite endpoint (death, cardiovascular hospitalisation, treatment failure), respectively.

Results

A total of 129 patients were included in the study with a mean follow-up of 4.1 years. 31% (40/129) of patients had increased RVSP (=/> 35 mmHg). 9 (10.1%) out of the 89 responders and 18 (45%) out of the 40 non-responders reached the composite endpoint of death, cardiovascular hospitalization or technique failure. Responder status is an independent predictor for reaching the composite endpoint and is associated with a survival benefit.

Conclusion

Increased RSVP is associated with adverse clinical outcomes in patients on intensive home hemodialysis.

VariableUnadjusted OR (95% CI)p valueAdjusted OR (95% CI)p value
Non vs Responders4.80 (2.15-10.7)<0.014.40 (1.93-9.99)<0.01
Diabetes2.89 (1.30-6.42)<0.012.27 (0.97-5.32)0.06
Age1.03 (1.00-1.07)0.021.01 (0.98-1.05)0.28
Smoking Status0.66 (0.22-1.92)0.270.55 (0.19-1.61)0.19

Cox proportional hazards analysis of the risk of the composite end point of death, technique failure and CV-related hospitalization.

Composite end point-free survival in responders and non-responders.

Funding

  • Private Foundation Support