Abstract: SA-PO515
Differences in Cardiovascular Phenotype and Pharmacotherapy Between Patients with ESKD Based on Transplant Eligibility
Session Information
- Hypertension and CVD: Clinical - II
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Adenwalla, Sherna F., University of Leicester Department of Cardiovascular Sciences, Leicester, United Kingdom
- Burton, James, University of Leicester Department of Cardiovascular Sciences, Leicester, United Kingdom
- March, Daniel Scott, University of Leicester Department of Cardiovascular Sciences, Leicester, United Kingdom
- Stannard, Rachael, University of Leicester Department of Population Health Sciences, Leicester, United Kingdom
- Graham-Brown, Matthew, University of Leicester Department of Cardiovascular Sciences, Leicester, United Kingdom
Background
Cardiovascular disease (CVD) is a major cause of death in end-stage kidney disease (ESKD) patients, linked to traditional and non-traditional risk factors. The ISCHAEMIA-CKD trial indicated no benefit from early invasive treatment for coronary artery is disease (CAD) in advanced kidney disease. Hence, optimizing conservative medical therapy is crucial. We conducted post-hoc analyses using CYCLE-HD trial data to compare structural and functional heart disease and pharmacotherapy in patients active and not active on the transplant waiting list.
Methods
130 hemodialysis patients underwent cardiac MRI for comprehensive cardiovascular phenotyping (2015-18). Appropriate comparison tests were used depending on data distribution. If initial testing revealed a significant difference, ANCOVAs were used to adjust for age.
Results
71/130 patients were active and 59/130 were not active on the transplant list. The ‘active’ group were younger (53 (40, 61) vs 66 (57, 75) years). 68% vs 79% were male, 69% vs 64% had hypertension, 20% vs 10% had dyslipidemia, 30% vs 48% had diabetes. There were no significant differences in medication use: 15% vs 8% on an ACE inhibitor or ARB, 48% vs 41% on a beta blocker, 50% vs 37% on a calcium channel blocker, 28% vs 32% on aspirin, 45% vs 61% on a statin. After adjusting for age, left ventricular (LV) ejection fraction, global longitudinal, and circumferential strain were significantly lower in the ‘not active’ group and LV mass index was higher (Table 1).
Conclusion
In this analysis, pharmacotherapy to mitigate CVD was poor irrespective of transplant listing status. CV phenotype was different between those listed and those not listed. Greater attention must be paid to optimising CV pharmacotherapy in both groups of patients to improve CV outcomes.
Table 1: Cardiac MRI characteristics