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Abstract: SA-PO364

Longitudinal Changes of Left Ventricular Diastolic Function and Fibroblast Growth Factor 23 in Young Hemodialysis Patients

Session Information

  • Pediatric Nephrology - III
    November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1900 Pediatric Nephrology

Authors

  • Seeherunvong, Wacharee, University of Miami School of Medicine, Miami, Florida, United States
  • Katsoufis, Chryso P., University of Miami School of Medicine, Miami, Florida, United States
  • Defreitas, Marissa J., University of Miami School of Medicine, Miami, Florida, United States
  • Swaminathan, Sethuraman, University of Miami School of Medicine, Miami, Florida, United States
  • Abitbol, Carolyn L., University of Miami School of Medicine, Miami, Florida, United States
  • Freundlich, Michael, University of Miami School of Medicine, Miami, Florida, United States
Background

Left ventricular diastolic dysfunction (DD) occurs early in patients on hemodialysis. Both traditional factors like hypertension and non-traditional factors including fibroblast growth factor-23 (FGF23) levels, erythropoietin, and treatment with vitamin D receptor activators such as paricalcitol may affect the progression of DD. Our objectives were to investigate the association of longitudinal changes of diastolic function with FGF23 levels and treatment with paricalcitol and erythropoietin in young dialysis patients.

Methods

Conventional and tissue Doppler imaging measurements and their respective age-adjusted Z-scores were used to measure early (E), late (A) diastolic transmitral flow velocities, corresponding mitral annular tissue velocities (e’ and a’), and to evaluate DD in 20 young hemodialysis patients age 16.7±3.6 years. DD was defined as an abnormal Z-score of E, A, E/A or E/e’ ratios. We analyzed associations of longitudinal DD changes with sequentially measured FGF23 levels, and with doses of erythropoietin and paricalcitol administered while on maintenance hemodialysis throughout a period of 7.1 ± 2.1 months.

Results

Compared with the standardized healthy age-matched controls, echocardiographic markers of diastolic function by Z-score cutoff revealed DD in 93% at baseline and 90% at follow-up. FGF23 levels were markedly elevated at baseline and follow up (25,238 ± 30,244 and 19,153 ± 25,191 RU/ml, respectively). FGF23 levels correlated only with the baseline mitral E/e’ ratio, but not with any other measurement of diastolic function. Hypertension correlated with DD. Paricalcitol dose was associated with improved diastolic function while erythropoietin dose showed no correlation with FGF23 levels or diastolic function.

Conclusion

In young hemodialysis patients, DD is highly prevalent. Elevated FGF23 levels and hypertension may contribute to DD. Erythropoietin is neither associated with FGF23 levels nor with DD while paricalcitol may attenuate DD.