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Abstract: TH-PO183

Fluid Volume Overload and Vascular Stiffness in Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Lafta, Aya, University of Alberta, Edmonton, Alberta, Canada
  • Ukrainetz, Judy A., Alberta Health Services, Edmonton, Alberta, Canada
  • Bello, Aminu K., University of Alberta, Edmonton, Alberta, Canada
  • Braam, Branko, University of Alberta, Edmonton, Alberta, Canada
Background

Fluid overload (FO) and vascular stiffness are prominent features of end-stage renal disease patients. Although both are risk factors for cardiovascular events, the relationship between these two factors has not yet been fully elucidated. We hypothesized that FO is associated with high vascular stiffness which can only be partly corrected by ultrafiltration (UF) of fluid during the hemodialysis (HD). We aimed to determine whether vascular stiffness is higher in fluid overloaded (FO) vs. non-fluid overloaded (non-FO) HD patients. Also, we investigated the effect of fluid removal on vascular stiffness of a single HD run.

Methods

Fluid status and arterial stiffness were tested in 20 FO and 19 non-FO HD patients. 26 healthy subjects were evaluated as controls. Fluid status was assessed by bioimpedance spectroscopy device. Pulse wave velocity (PWV) and augmentation index (AIx), as markers of vascular stiffness, were measured using Arteriograph24TM. The PWV and AIx were performed for 5 hours, starting 30 minutes before and ending 30 minutes after the HD run. All measurements were done during the mid-week HD session. In healthy controls, 5-hour measurement of PWV and AIx was performed as time control. HD subjects were divided into three tertiles according to the baseline PWV measurement.

Results

The median age of HD patients was 60 (29-56) and 49 (29-56) years in healthy subjects. Fluid status in healthy controls, FO and non-FO HD patients was 0.05 (-0.6-0.5), 2.9 (1.7-5.2), and 0.3 (-0.3-0.6), respectively. As anticipated, PWV and AIx were higher in HD patients vs. healthy controls. FO was not associated with a higher PWV (m/s) in FO 10.0 (9.2-11.1) vs non-FO 10.0 (8.8-11.4) HD groups. A significant positive linear relationship was observed between dialysis UF (L) and intradialytic PWV changes in the upper-tertile group (r2= 0.223; P<0.05). The latter group showed significant changes in AIx (%) -20.0±55.5 compared to the lower-tertile 15.7±27.1 (P<0.05).

Conclusion

The PWV and AIx were higher in HD patients compared to healthy subjects. Surprisingly, there was no difference in PWV/AIx between the two HD groups. Dialysis treatment appears to be a detrimental factor in improving the vascular status of patients with higher PWV and/ or AIx. However, an additional interventional study would be needed to further delineate the relationship between fluid status and arterial stiffness.