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Abstract: PO0869

Coronary Artery Calcification Is a Risk Factor for Intradialytic Hypotension in Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Mizuiri, Sonoo, Iryo Hojin Ichiyokai Harada Byoin, Hiroshima, Japan
  • Nishizawa, Yoshiko, Iryo Hojin Ichiyokai Harada Byoin, Hiroshima, Japan
  • Doi, Toshiki, Iryo Hojin Ichiyokai Harada Byoin, Hiroshima, Japan
  • Yamashita, Kazuomi, Iryo Hojin Ichiyokai Harada Byoin, Hiroshima, Japan
  • Shigemoto, Kenichiro, Iryo Hojin Ichiyokai Harada Byoin, Hiroshima, Japan
  • Usui, Koji, Ichiyokai Ichiyokai Clinic, Hiroshima, Japan
  • Arita, Michiko, Ichiyokai East Clinic, Hiroshima, Japan
  • Naito, Takayuki, Ichiyokai Yokogawa Clinic, Hiroshima, Japan
  • Doi, Shigehiro, Hiroshima Daigaku Byoin, Hiroshima, Japan
  • Masaki, Takao, Hiroshima Daigaku Byoin, Hiroshima, Japan
Background

Vascular calcification and intradialytic hypotension (IDH) share common risk factors in hemodialysis (HD) patients, but there are few reports about the association. We investigated the association between IDH and coronary artery calcification (CAC) and their effects on mortality in HD patients.


.

Methods

Subjects were consecutive maintenance HD patients. IDH was defined as nadir systolic blood pressure <100 mmHg, or the requirement for bolus infusion of saline and vasopressor (etilefrine hydrochloride) during at least two of 10 HD sessions. Laboratory data and Agatston coronary artery calcium score (CACS) were obtained at baseline. Logistic regression analyses for CACS and Cox analyses for mortality were conducted.

Results

In all subjects (n=173), age and dialysis vintage were 66±12 years and 102±89 months, respectively. IDH occurred in 37 patients (21.4%), and CACS was higher in the IDH group than in the non-IDH group [1,845 (243–3,774) vs. 884 (161–2,465)]. IDH was significantly (P<0.05) associated with CACS [odds ratio (OR): 1.01], diabetes (OR: 2.90), mean predialysis systolic blood pressure (OR: 0.93), mean ultrafiltration (OR: 1.92), Kt/Vurea (OR: 11.27) and erythropoietin responsive index (ERI) (OR: 0.91), but not with serum albumin or use of calcium channel blockers. For 3-year all-cause mortality, the cut-off value of CACS, determined by receiver operating characteristics curve analysis, was 1,829 with sensitivity of 69% and specificity of 77%. Of the 173 patients, 45 all-cause deaths and 19 cardiovascular (CV) deaths occurred for 3 years. Patients with both IDH and CACS ≥1,829 had the highest 3-year cumulative CV death rate (33.3%, P<0.01) compared with 19.7%, 11.5%, and 4.5% in those with CACS ≥1,829 only, IDH only, and neither, respectively. In Cox models including age, sex, diabetes, albumin, phosphate, CRP, ERI and FGF23, hazard ratios (HRs) for 3-year all-cause mortality of IDH, CACS ≥1,829, or IDH with CACS ≥1,829 were similar, but HR for 3-year CV mortality was the highest in IDH with CACS ≥1,829 (9.68, P<0.001) compared with 7.29 (P<0.01) and 6.77 (P<0.01), in those with CACS ≥1,829 only, and IDH only.

Conclusion

CACS is an independent risk factor for IDH, and CACS provide additional risk-discrimination over IDH for CV mortality in HD patients.

Funding

  • Private Foundation Support