Abstract: SA-PO858
Dose-Effect Response of Remote Ischemic Preconditioning for the Prevention of Hemodialysis-Induced Myocardial Stunning: Preliminary Results of a Randomized Controlled Trial
Session Information
- Dialysis: Cardiovascular, BP, Volume
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Salerno, Fabio R., University of Western Ontario, London, Ontario, Canada
- Crowley, Lisa, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
- Penny, Jarrin D., London Health Sciences Centre, London, Ontario, Canada
- McIntyre, Christopher W., University of Western Ontario, London, Ontario, Canada
Background
Myocardial stunning is a common complication of standard hemodialysis and is implicated in the high cardiovascular mortality of end-stage kidney disease patients. This is an interim analysis of a randomized controlled trial aimed at testing the effects of different doses of remote ischemic preconditioning (RIPC) for the prevention of hemodialysis-induced myocardial stunning.
Methods
Study patients underwent speckle-tracking echocardiography predialysis and at peak stress (15 minutes before the end) at each visit. Images were analyzed for longitudinal systolic strain and the number of new regional wall motion abnormalities (RWMAs) (> 30% reduction in longitudinal systolic strain at peak stress) was recorded. Patients were screened for myocardial stunning (>/= 2 RWMAs) before enrolment: so far, 13 chronic hemodialysis patients showing evidence of hemodialysis-induced myocardial stunning were enrolled. Patients were followed-up for 4 weeks, once a week. They were randomized in a 1:1 ratio to receive either: predialysis Sham RIPC, Low-dose RIPC (2 RIPC cycles on visit 1), Standard RIPC (4 cycles on visit 1) or High-dose RIPC (4 cycles at each visit). Primary outcome was the reduction in RWMAs.
Results
See attached image.
Conclusion
These preliminary results show a trend towards a dose-effect response to RIPC: sham and low-dose RIPC failed at reducing hemodialysis-induced RWMAs, while standard and high-dose RIPC seem effective in preventing hemodialysis-induced myocardial stunning. These effects seem to last for at least 2 weeks after the delivery of the RIPC stimulus. We expect to confirm our hypotheses with further enrollments.
Mean (+ Standard Deviation) RWMAs per group per visit. The RIPC stimulus was administered on visit 1 for the Sham, Low-dose and Standard groups and on visits 1 through 4 for the High-dose. Differences were not statistically significant.
Funding
- Government Support - Non-U.S.