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Abstract: PO1785

Cardiovascular Functional Changes in Transplant Waitlist Dialysis Patients

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Umukoro, Peter Eloho, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Lu, Tzongshi, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Moe, Sharon M., Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Moorthi, Ranjani N., Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Mcgregor, Gordon, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, Coventry, United Kingdom
  • Hiemstra, Thomas F., University Hospitals Coventry and Warwickshire NHS Trust, Coventry, Coventry, United Kingdom
  • Lim, Kenneth, Indiana University School of Medicine, Indianapolis, Indiana, United States
Background

The transition to dialysis is a crucial time in patients with advanced chronic kidney disease (CKD), conferring an increased risk for cardiovascular death. We recently showed that VO2Peak, an index of cardiovascular functional capacity (CFC) significantly declined in advanced CKD patients following 1-year follow-up in the absence of changes in left ventricular mass index (LVMI). Herein, we hypothesized that initiating dialysis and continuing dialysis could worsen an individual’s CFC over time.

Methods

We conducted a cross-sectional study of 241 CKD stage 5 patients from the Cardiopulmonary Exercise Testing in Renal Failure (CAPER) cohort. VO2Peak (primary endpoint) was assessed by cardiopulmonary exercise testing (CPET) in parallel with transthoracic echocardiography.

Results

Of the 241 patients (mean age [SD] age, 48.9 [14.9] years; 154 [63.9%] male), n=42 patients were pre-dialytic (mean eGFR [SD], 14 [3.4] ml/min/1.73m2), n=66 were in tertile 1 of dialysis vintage (0-17 months), n=69 in tertile 2 (18-50 months) and n=64 in tertile 3 (≥51 months). Predialysis patients had an impaired VO2Peak of 22.7 [5.2] ml/min/kg, and this significantly declined to 18.5 [5.5] ml/min/kg in tertile 1 dialysis patients. Compared to the pre-dialysis group, tertile 1 dialysis patients exhibited reduced maximal workload (p=0.003), impaired maximal heart rate (p=0.02), increased LVMI (p<0.001) and markedly elevated FGF23 levels (p=0.01). On assessment of the effects of dialysis vintage, we found an incremental downward trend in VO2Peak across the groups (19.1 [5.2] tertile 1, 18.0[4.7] tertile 2, 16.9[4.2] ml/min/kg) following exclusion of patients who had prior kidney transplants, however this did not reach statistical significance (p=0.2).

Conclusion

Initiating dialysis in advanced CKD patients is associated with impaired CFC comparable to declines seen in new onset heart failure, making this a critical time for these patients.