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Kidney Week

Abstract: SA-PO1039

Epidemiology of Pericardial Effusions in Patients with ESRD on Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Gasimli-Gamache, Leyla, Stony Brook University Hospital, Stony Brook, New York, United States
  • Vijayakumar, Shilpa, Stony Brook University Hospital, Stony Brook, New York, United States
  • Sahib, Haseena, Stony Brook University Hospital, Stony Brook, New York, United States
  • Taub, Erin M., Stony Brook University Hospital, Stony Brook, New York, United States
  • Ahmad, Sahar, Stony Brook University Hospital, Stony Brook, New York, United States
  • Mallipattu, Sandeep K., Stony Brook University Hospital, Stony Brook, New York, United States
Background

Cardiovascular disease, including pericardial disease, remains a prominent cause of morbidity and mortality in patients with end-stage renal disease (ESRD). The prevalence, clinical and prognostic significance of pericardial effusions (PE) in ESRD patients has not been well established. This study examines the epidemiology of PE in patients on chronic hemodialysis (HD).

Methods

This was an observational, retrospective study of chronic HD patients (> 2 months on HD) from Stony Brook University Hospital Kidney Center from January 1, 2010 to November 31, 2017 with analysis of transthoracic echocardiograms (TTE) along with corresponding clinical and demographic data. Effusions were classified by size: trivial (< 5 mm), small (5-10 mm), moderate (10-20 mm), or large (≥ 20 mm) echo-free space in end-diastole, as per European Society of Cardiology guidelines. Statistical analysis was conducted in SAS v9.4 using parametric and non-parametric tests as appropriate.

Results

A total of 185 TTEs from 82 patients on HD were analyzed. Twenty-nine (35.4%) patients had some degree of PE. Sixteen (19.5%) patients had trivial, thirteen (15.9%) had small, five (6%) had moderate and two (2.4%) had large (including one with tamponade physiology requiring pericardiocentesis) PE. Eighteen patients had multiple TTEs during the study period and were found to have varying degrees of PE (ranging from none to moderate). Patients with PE had a significantly lower median age compared to those who did not have PE (54 years old vs. 65 years old), with the moderate/large effusions primarily observed in relatively younger patients (median age of 46). Patients with lower serum albumin levels had significantly higher numbers of PEs, with the most severe PEs seen in the groups with the lowest albumin levels (3.2 g/dL). Patients with PE also had a lower mean hematocrit level compared to those without PE (29.6% vs. 32.7%). No significant association was found between the presence of PE and gender, ethnicity, cardiac ejection fraction, change in weight compared to dry weight, urea reduction ratio, or kt/v.

Conclusion

Approximately one-third of patients on chronic HD therapy had some degree of PE. In this study, relatively younger age, lower levels of serum albumin and lower hematocrit were independently associated with increased prevalence of PE.