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Abstract: TH-PO279

Cytokines Associated With Changes in Echocardiographic Parameters After Arteriovenous Fistula Creation in Hemodialysis Patients

Session Information

Category: Dialysis

  • 703 Dialysis: Vascular Access

Authors

  • Duque, Juan Camilo, University of Miami School of Medicine, Miami, Florida, United States
  • Manzur-Pineda, Karen, University of Miami School of Medicine, Miami, Florida, United States
  • Martinez, Laisel, University of Miami School of Medicine, Miami, Florida, United States
  • Montoya, Christopher, University of Miami School of Medicine, Miami, Florida, United States
  • Dejman, Adriana, University of Miami School of Medicine, Miami, Florida, United States
  • Tabbara, Marwan, University of Miami School of Medicine, Miami, Florida, United States
  • Vazquez-Padron, Roberto I., University of Miami School of Medicine, Miami, Florida, United States
Background

Pulmonary hypertension (PH) is common in patients with end-stage kidney disease (ESKD) and is associated with increased all-cause and cardiovascular mortality. It is widely believed that arteriovenous fistula (AVF) creation and long-term hemodialysis contribute to the pathogenesis and/or exacerbate PH. Systemic cytokines are elevated in CKD and ESKD patients compared with the general population. However, whether cytokine levels interfere with vascular and cardiac remodeling after AVF creation remains unknown. There is scarce data on the long-term effect of AVF creation and cytokine expression on PH and echocardiographic changes.

Methods

A retrospective study of 38 patients who underwent AVF creation between 2019 and 2020. Cytokine levels, including chemokines, interferons, interleukins, and growth factors, were measured in preoperative plasma samples using multiplex and echocardiographic evaluations before and after surgery. A stepwise linear regression analysis was performed looking for the correlation between right ventricular systolic pressure (RVSP) change pre- and post-AVF and demographic traits, comorbidities, cytokines, and other echocardiographic parameters such as right atrial pressure (RAP) during systole, left ventricular mass (LVM), tricuspid regurgitation (TR), mitral E/E’ ratio, and ejection fraction (EF).

Results

The median time for the preoperative echocardiogram was 0.3 years (interquartile range [IQR] 0.2-0.7 years) before AVF creation, while the follow-up echo was done 1.3 (0.6-2.1) years after surgery. Thirty-seven percent of the patients had RVSP>37 mmHg at baseline. The RVSP after AVF creation decreased in 29% of the patients, and 24% remained stable. There was a significant decrease in LVM (224 [171-285] vs. 194 [147-236], P=0.045) after surgery. Smoking (p=0.047), along with high levels of GRO (p=0.001) and TGFb-1 (p=0.012), are associated with worsening of RVSP post-AVF creation, while high levels of IL-4 (p=0.002) are associated with an improvement in RVSP post-AVF creation.

Conclusion

Our results suggest that elevated systemic cytokines pre and post AVF creation are associated with a significant elevation of RVSP in the ESKD population.

Funding

  • NIDDK Support