Abstract: SA-PO870
Inflammation Is an Amplifier of Lung Congestion by High LV Filling Pressure in Hemodialysis Patients: A Longitudinal Study
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
Author
- Torino, Claudia, National Research Council, Reggio Calabria, Italy
Group or Team Name
- on behalf of the LUST study working group*
Background
Lung congestion is exceedingly common in symptomatic and asymptomatic hemodialysis (HD) patients. Since inflammation alters vascular permeability, including vascular permeability in the lung, we hypothesized that it can be an amplifier of lung congestion in HD patients.
Methods
We investigated the effect modification by systemic inflammation as measured by serum C Reactive Protein (CRP) on the longitudinal relationship between a surrogate of the filling pressure of the LV [left atrial volume (LAV)] and lung water in a series of 273 patients participating into the LUng congeSTion in hemodialysis patients trial (LUST). Lung water was quantified by the number of ultrasound B lines (US-B) registered over the thorax. Paired lung-US and LAV (Echo-CG) recordings were performed at baseline, 6, 2 and 24 months. Overall, 407 simultaneous US-Echo-C estimates were obtained during follow up. Data analysis was made by the mixed Linear Model.
Results
Ninety-two patients had mild to moderate lung congestion (5-30 B lines) and 33 severe congestion (>30 B lines). The median LAV was 73 ml (Inter Quartile Range 53-105). The longitudinal series of US-B lines associated with simultaneous estimates of LAV in analyses adjusting for age, gender, dialysis vintage, SBP, diabetes, smoking, cholesterol, calcium (P=0.001). Effect modification analysis by CRP showed that this biomarker of inflammation was a strong modifier of the LAV- US B lines relationship both in unadjusted and adjusted analyses (P<0.001) so that at an identical increase in LAV the number of US-B lines was higher in more severely inflamed than in patients with less severe inflammation.
Conclusion
These data extend to the lung the detrimental effects of inflammation in HD patients and suggest that, at comparable LV filling pressure levels, patients with more severe degrees of inflammation are exposed to higher risk for pulmonary edema than those with no or mild systemic inflammation.
*Mallamaci F,Gargani L,Sicari R,Letachowicz K,Ekart R,Fliser D,Covic A,Siamopoulos K,Stavroulopoulos A,Massy ZA,Fiaccadori E,Caiazza A,Bachelet T,Slotki I,Martinez-Castelao A,Coudert-Krier MJ,Rossignol P,Gueler F,Hannedouche T,Wiecek A,Sarafidis P,Klinger M,Hojs R,Seiler-Mussler S,Lizzi F,Siriopol D,Balafa O,Shavit L,Loutradis C,Tripepi R,Tripepi G,Picano E,London GM,Zoccali C.
Funding
- Private Foundation Support