Abstract: FR-OR005
Effect of Intensive Home Hemodialysis on Right Ventricular Systolic Pressure and Clinical Outcomes
Session Information
- Advances in Home Dialysis Modalities
October 26, 2018 | Location: 2, San Diego Convention Center
Abstract Time: 05:18 PM - 05:30 PM
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.
| Variable | Unadjusted OR (95% CI) | p value | Adjusted OR (95% CI) | p value |
| Non vs Responders | 4.80 (2.15-10.7) | <0.01 | 4.40 (1.93-9.99) | <0.01 |
| Diabetes | 2.89 (1.30-6.42) | <0.01 | 2.27 (0.97-5.32) | 0.06 |
| Age | 1.03 (1.00-1.07) | 0.02 | 1.01 (0.98-1.05) | 0.28 |
| Smoking Status | 0.66 (0.22-1.92) | 0.27 | 0.55 (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