Abstract: FR-PO743
Reversal of ESKD After 4 Years of Peritoneal Dialysis (PD) With Improved Cardiorenal Pathophysiology
Session Information
- Hypertension and CVD: Clinical, Outcomes, Trials
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1502 Hypertension and CVD: Clinical‚ Outcomes‚ and Trials
Authors
- Sharma, Akash, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
- Patel, Rahul, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
- Bansal, Shweta, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
Introduction
Inadequate treatment of malignant hypertension (MHTN) results in multi-organ failure and sets up a pathophysiologic disequilibrium between heart and kidney where impairment of one causes malfunction of the other. We present a case of MHTN related ESKD who improved his kidney and diastolic dysfunction after 4 years on PD from improved cardiorenal interactions.
Case Description
A 39-year male with 10-year history of smoking and HTN on sporadic medications presented with fatigue and vomiting, BP was 230/150 mmHg, and serum creatinine (SCr) was 7.5mg/dl. Exam showed papilledema and 1+ peripheral edema. Pertinent blood work included anemia, normal platelets, high troponin, and potassium 3.2 mEq/L. Urine without blood but 1.7 gm 24H protein. Acute coronary syndrome and secondary hypertension were ruled out. Echo showed severe concentric left ventricular hypertrophy (LVH), moderate diastolic dysfunction (DD) and pulmonary arterial systolic pressure of 48 mmHg. Renal biopsy showed tubular atrophy and interstitial fibrosis in 80% cortex and severe hyperplastic obliterative arterial and arteriolar sclerosis with no acute damage. After initial BP control, he was discharged on oral carvedilol, nifedipine, hydralazine, and furosemide and plan to start PD as outpatient. Training and education let him change his lifestyle mainly by dietary sodium reduction, and he followed best PD practices. BP improved to <115/80 mmHg with no edema over next few months. He was kept on low dose carvedilol and lisinopril for cardiorenal protection and furosemide. His SCr settled at 10 mg/dl and stayed there for 2 years, when echo showed no LVH and mild DD. He had no PD related infections and maintained 1-1.5L/d urine output. Over the 3rd year SCr lowered to 6-7mg/dl and 4th year to 4-5mg/dl when PD was stopped. SCr was 3.2mg/dl 6 months later (eGFR 24ml/min) with urine protein-Cr ratio 1.6g/g. BP remained at goal with same medications. Echo had normalization of DD.
Discussion
This is a rare case of reversal of ESKD after 4 years due to maintenance of euvolemia and BP control from significant lifestyle changes and daily PD, resulting in resolution of DD and likely improved renal perfusion and healing of remanent nephrons. It highlights the important cardiorenal interactions and need for aggressive BP/volume control to achieve best outcomes.