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Kidney Week

Abstract: PO1349

Right Heart Dysfunction in Hemodialysis Patients

Session Information

  • Vascular Access
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Wing, Richard E., University of Rochester Medical Center, Rochester, New York, United States
  • Gagnier, Michael R., University of Rochester Medical Center, Rochester, New York, United States
  • Thakur, Ajay K., University of Rochester Medical Center, Rochester, New York, United States
  • Tsai, Peihsuan R., University of Rochester Medical Center, Rochester, New York, United States
  • Storozynsky, Eugene, University of Rochester Medical Center, Rochester, New York, United States
  • Le, Thu H., University of Rochester Medical Center, Rochester, New York, United States
Background

Despite emerging evidence that right ventricular dysfunction (RVD) is a major determinant of outcome, previous studies have largely neglected the RV in ESRD patients.

Methods

We conducted a cross-sectional study on patients who received maintenance hemodialysis (HD) between Jan 1 - Dec 31, 2010 and were cared for by URMC nephrology faculty. For this cohort, all ambulatory trans-thoracic echocardiograms (TTEs) between Jan 1 2010 and Dec 31, 2018 were identified. Only TTEs with images of sufficient quality to assess the RV were included. Those with pre-existing congenital heart disease, atrial fibrillation, or prior valve surgery were excluded. Subjects might have more than one included TTE. Data from subject's charts were extracted.

Results

We identified 425 individuals on HD. Of these, there were 141 ambulatory TTEs, of which 64 TTEs met all inclusion criteria. RVD is defined as abnormality in any of the following echocardiographic parameters: S' (< 9.5 cm/sec), TAPSE ( < 17 mm), Free Wall Right Heart Strain ( > - 20%), or RV Fractional Area Change (< 35%). Of the 64 TTEs, 19 had one or more parameters indicating RVD. Select findings with bivariate analysis are summarized in the Table 1. Continuous variables are expressed as means (S.D.) and analyzed by ANOVA.

By multivariate logistic regression, dialysis vintage < 10 years, history of vascular disease, and absence of AVS were associated with RVD. There was a trend with OSA. Limitations include retrospective analysis, small numbers, and heterogeneity in patients with respect to history of dialysis access type prior to undergoing TTE.

Conclusion

RVD is common finding on TTEs in HD patients, but is under recognized. A larger prospective study is needed to identify factors that are associated with development of RVD that could potentially be modifiable.

Table 1
 Whole GroupNormalRVDP Value
 N=64N=45N=19 
     
Male Sex35.9%37.8%31.6%0.637
Age in years50.2 (11.8)48.6 (11.9)53.8 (10.8)0.109
African American53.1%53.3%52.6%0.959
Vintage in years9.88 (5.8)10.9 (6.3 )7.5 (3.8 )0.032
     
OSA26.6%20.0%42.1%0.067
Vascular Disease25.0%17.8%42.1%0.040
AVS present84.4%91.1%68.4%0.023