Abstract: TH-PO204
Over-Ultrafiltration May Increase the Risk of Ischemic Cerebral Small Vessel Disease in Hemodialysis Patients
Session Information
- Hemodialysis and Frequent Dialysis - I
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Zheng, Ke, Peking Union Medical College Hospital, Beijing, China
- Qian, Yujun, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Dongcheng District, Beijing, BEIJING, China
- Wang, Haiyun, Peking Union Medical College Hospital, Beijing, China
- Li, Xuemei, Peking Union Medical College Hospital, Beijing, China
Background
Cerebral small vessel disease (CSVD) is an important cause and risk factor of stroke and dementia. Recently, CSVD in patients with end-stage renal disease and undergoing dialysis had attracted great attentions. A higher prevalence of CSVD in hemodialysis patients had been shown in others’ and our previous studies. Hemodialysis is a complicated procedure with multiple factors that could affect cerebrovascular disease. Ultrafiltration could bring hemodynamic instability during the hemodialysis. The aim of this study is to discovery the relationship between ultrafiltration and ischemic CSVD
Methods
In this retrospective study, we collected a whole year’s ultrafiltration information before the brain MRI scan of the HD participants in our dialysis cohort of 2013~2014 CSVD/CI study in which the CSVD were assessed by magnetic resonance imaging. We analyzed average ultrafiltration volume (UV mean), fluctuation of ultrafiltration volume (UV CV) and ultrafiltration volume over 6% dry weight (UV mean - 6%W), and their influence to ischemic CSVD findings (lacune and white matter hyperintensity) in MRI. Multivariable analysis was used to explore the relevance between ultrafiltration parameters and CSVD.
Results
In our 2013~2014 dialysis CSVD/CI cohort, 119 participants were on HD, and among them, 50.9% were male. The average age was 56.6yr, average dialysis vintage was 58 months. Median UV mean was 2.3 (0.2~ 4.6) L, UV CV was 21.4 (0.0 ~ 78.1) mL and “UV mean - 6%W” was -1.3 (-4.6 ~ 1.4) kg. The prevalence of lacune in MRI was 28.6% and WMH was 38.7%. By multivariable analysis, we found that UV and UV CV were not relative to both features of CSVD, but the “UV mean - 6%W” was relative to increased risks for lacune and WMH with OR1.74 (1.06, 2.87) and 1.89 (1.16, 3.08), respectively. In further analyzed, it showed that ultrafiltration mainly affected subcortical white matter lacune (OR 1.98 (1.09, 3.59)) and periventricular white matter hyperintensities (OR1.81 (1.08, 3.03)), rather than deep CSVD lesions.
Conclusion
Over ultrafiltration during hemodialysis procedure could increase the risk of ischemic CSVD, especially the risk of subcortical white matter lacune and periventricular white matter hyperintensities. “6% dry weight” could be considered as ultrafiltration cut-off values in hemodialysis therapy in order to avoid ischemic CSVD.