Abstract: PUB085
Can We Control Cardiovascular Risk Factors Among Patients with ESKD on Hemodialysis?
Session Information
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Nieto, Javier, Hospital General Universitario de Ciudad Real, Ciudad Real, CM, Spain
- Anton, Gloria, Avericum, Telde, Gran Canaria, Spain
- Pobes Martínez de Salinas, Alfonso, Hospital de Cabuenes, Gijón, Asturias, Spain
- Ahijado, Francisco Javier, Hospital Universitario de Toledo, Toledo, CM, Spain
- Martinez Esteban, Maria Dolores, Hospital Regional Universitario de Malaga, Málaga, AL, Spain
- Abellán Alemán, José, Universidad Catolica San Antonio de Murcia, Murcia, Region of Murcia, Spain
Group or Team Name
- The Spotlight Objective Study Investigators.
Background
Cardiovascular (CV) disease is the leading cause of morbi-mortality among patients with CKD, including ESKD on hemodialysis. Control of their cardiovascular risk factors (CVRF) is often inadequate; lack of adherence and therapeutic inertia are proposed as causes of failure to achieve these goals. Our purpose is to evaluate these main CVRF (hypertension, diabetes, dyslipidemia) in a Spaniard population of hemodialysis patients and how we can improve them.
Methods
Multicenter, interventional, prospective study under routine clinical practice in 501 patients with ESKD on hemodialysis. They were randomly selected from 20 dialysis centers throughout Spain. According to European CV risk guidelines, control criteria were: blood pressure (BP) <140/90mmHg; dyslipidemia (LDL-C <55mg/dL); diabetes (HbA1c <7% or <8% if ≥80 years of age). Monthly follow-ups were conducted for four months, collecting anthropometric parameters, adherence, and laboratory tests. Treatment could be freely modified in cases of poor control.
Results
Of the 501 patients (157f, 344m), mean age 68y, 471 (94%) were hypertensive (H), 238 (47%) diabetic (DM), 397 (79%) dyslipidemic (Dy), 207 (41%) were simultaneously H+DM+Dy. Initially the CVRF control was: H 216 (45%); DM 152 (65%); and Dy 197 (50%). Only 38 patients (7.5%) achieved control of H+DM+Dy simultaneously. In 5.4% (27 patients), none of these factors were controlled. Among diabetic patients, 16% had all three factors controlled, while 11.3% had all CVRFs uncontrolled. After a brief intervention, H control improved from 45% to 52% (p <0.01), DM control from 65% to 64% (p =ns), and Dy control from 50% to 56% (p <0.01). Patients with control of H+DM+Dy increased from 7.5% to 10.2%, while those without control of any of CVRF decreased from 5.4% to 3.2%. 20% of patients were non-compliant at first, which decreased to 7% at the end of the study.
Conclusion
Among the population of patients with ESKD on hemodialysis in Spain, CVRF control is notably poor. 92.5% of patients were out of control goals defined by international CV risk guidelines. An improvement in CVRF control was observed after a brief intervention. However, despite favorable outcomes in adherence, only 10.2% of patients achieved it. Therapeutic inertia continue to be an obstacle to achieving these goals.