Abstract: FR-PO347
Impact of Dialysis Access on Right Heart Function
Session Information
- Hypertension and CVD: Clinical, Outcomes, Trials
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1402 Hypertension and CVD: Clinical, Outcomes, and Trials
Authors
- Kennedy, Jamie L w, University of Virginia, Charlottesville, Virginia, United States
- Holsten, Laura, University of Virginia, Charlottesville, Virginia, United States
- Aktan, Idil, University of Virginia, Charlottesville, Virginia, United States
- Mihalek, Andrew D., University of Virginia, Charlottesville, Virginia, United States
- Mazimba, Sula, University of Virginia, Charlottesville, Virginia, United States
- Bowman, Brendan T., University of Virginia, Charlottesville, Virginia, United States
- Doyle, Alden Michael, University of Virginia, Charlottesville, Virginia, United States
- Le, Thu H., University of Virginia, Charlottesville, Virginia, United States
Background
Arteriovenous shunts (AVS) are the preferred hemodialysis (HD) access over central venous catheters (CVC) due to lower rates of infection and venous complications. However, AVS may be associated with a higher prevalence of pulmonary hypertension (PH), which is linked to poor kidney transplant outcomes. We assessed the relationship between dialysis access and right heart (RH) function (RHF) in a cohort of patients referred to our center for kidney transplantation.
Methods
We conducted a retrospective analysis of patients who underwent transthoracic echocardiogram (TTE) evaluation. We assessed the frequency of PH with estimated pulmonary artery systolic pressure (PASP) ≥ 50 mmHg, right ventricular (RV) dysfunction, and moderate or greater tricuspid regurgitation (TR). Analyses were performed with SAS, using either chi square, ANOVA, or Fisher’s exact test.
Results
We identified 448 patients with TTE and known dialysis access: 69.2% AVS, 19.4% CVC, and 11.4% peritoneal dialysis (PD). Demographics and comorbid conditions were similar across access groups, with the exception of gender and dialysis duration (See Table). The prevalence of RH dysfunction (PH, TR, and RV dysfunction) was lowest in PD patients. Among HD patients, TR was significantly more common in CVC than AVS patients, whereas PH and RV dysfunction were not different. Linear regression modeling of estimated PASP found access, age, and diabetes as significant predictors, and again favored PD over CVC and AVS.
Conclusion
PD patients were less likely to have RH dysfunction than HD patients. The effect of CVC vs AVS was less clear; TR was more common in CVC patients while there was no difference in PH and RV dysfunction. Dialysis access decisions are not randomized, possibly leading to differences unaccounted for in our analysis.
| CVC (n=87) | AVS (n=310) | PD (n=51) | P value | |
| Age (mean ± SD) | 55.8 ± 17.5 | 56.3 ± 13.4 | 55.9 ± 12.8 | 0.9424 |
| Male (%) | 49.4 | 59.5 | 70.6 | 0.047 |
| Months on Dialysis (mean ± SD) | 31.3 ± 28.7 | 40.2 ± 30.2 | 28.5 ± 15.5 | 0.0028 |
| Hypertension (%) | 87.4 | 92.3 | 86.3 | 0.2016 |
| Diabetes Mellitus (%) | 51.7 | 57.7 | 52.9 | 0.5431 |
| Coronary Artery Disease (%) | 26.4 | 21 | 17.7 | 0.4227 |
| Obesity (%) | 19.5 | 23.9 | 17.7 | 0.4819 |
| PH (%) | 11.5 | 8.7 | 0 | 0.0244 |
| RV dysfunction (%) | 23.5 | 15.3 | 4.2 | 0.0106 |
| TR (%) | 12.9 | 6.4 | 0 | 0.0122 |