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Abstract: SA-PO584

Cardiac Autonomic Innervation Is Decreased in Postmortem Tissue from Individuals with ESKD Compared with Those Without

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Soomro, Qandeel H., New York University Grossman School of Medicine, New York, New York, United States
  • Mezzano, Valeria, New York University Grossman School of Medicine, New York, New York, United States
  • Narula, Navneet, New York University Grossman School of Medicine, New York, New York, United States
  • Charytan, David M., New York University Grossman School of Medicine, New York, New York, United States
Background

Cardiac innervation changes can lead to an imbalance in neural activation and arrhythmias. Although described in other disease states, changes in cardiac innervation have not been studied in ESKD.

Methods

Age and DM matched cases with ESKD and controls without ESKD (10/group) who underwent autopsy at NYU-affiliated hospitals (2012-2020) were identified. Demographic and CV history was collected from autopsy and medical records. Case and controls were selected based on availability of LV anterior wall sections without extensive fibrosis in the area of interest. We performed H&E staining, and immunohistochemistry for S100 (all nerves), Tyrosine hydroxylase (TH, sympathetic nerves) and trichrome staining for fibrosis. Staining and fibrosis were quantified within regions of interest in the epi-, mid- and endocardial ⅓ as density per mm2 (primary outcome) or fibrosis %.

Results

Mean age: ESKD 66.7 vs. controls 65.6 y, sex: 50% female in both groups and DM was (80% in both groups), whereas 60% were Black in the ESKD group vs. 40% in the control group. All ESKD patients had ischemic heart disease vs. with 30% of controls. Most common cause of death: myocardial infarction (50% in ESKD, 30% controls) followed by pump failure. Overall nerve density was lower in ESKD compared to controls: S100 density in the mid (63.97/mm2 vs. 106.7/mm2, P=0.04) and endocardial (62.6/mm2 vs. 203.2/mm2, P=0.003) thirds. Sympathetic nerve density was lower in dual-stained sections, particularly in the endocardial region (65.9/mm2 vs. 180.6/mm2, P=0.002). Fibrosis was higher in those with ESKD in all regions (epi= 0.009 vs. 0.005, mid= 0.024 vs. 0.006, endo=0.033 vs. 0.006, P= <0.05 for all). Fibrotic area was not correlated with nerve density (overall and for sympathetic nerves) in regions of interest (P> 0.05 for all).

Conclusion

Reduced overall nerve density and sympathetic innervation observed in ESKD. Further studies are needed to evaluate cardiac innervation patterns in ESKD and its link to arrhythmia.

Funding

  • Private Foundation Support