Kidney Week

Abstract: SA-PO863

Predictors of Change in Left Ventricular Mass in a Randomized Trial of Extended Hours Dialysis

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

• Smyth, Brendan, The George Institute for Global Health, UNSW, Newtown, New South Wales, Australia

Brendan Smyth,

• Chan, Christopher T., Toronto General Hospital, Toronto, Ontario, Canada

Christopher T. Chan,

• Puranik, Rajesh, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia

Rajesh Puranik,

• Gray, Nicholas A., Sunshine Coast University Hospital , Birtinya, Queensland, Australia

Nicholas A. Gray,

• de Zoysa, Janak Rashme, Waitemata District Health Board, AUCKLAND, New Zealand

Janak Rashme de Zoysa,

• Scaria, Anish, The George Institute for Global Health, UNSW, Newtown, New South Wales, Australia

Anish Scaria,

• Gallagher, Martin P., The George Institute for Global Health, UNSW, Newtown, New South Wales, Australia

Martin P. Gallagher,

• Perkovic, Vlado, The George Institute for Global Health, UNSW, Newtown, New South Wales, Australia

Vlado Perkovic,

• Jardine, Meg J., The George Institute for Global Health, UNSW, Newtown, New South Wales, Australia

Meg J. Jardine,

Background

Extended hours dialysis was not associated with a significant reduction in LVMI in the ACTIVE Dialysis trial. Other factors, such as changes in fluid status and biochemical parameters, may predict regression of LV hypertrophy. We aimed to determine predictors of change in left ventricular mass index (LVMI) in the ACTIVE Dialysis study.

Methods

In the ACTIVE Dialysis study patients randomised to extended and standard dialysis, received median 24 and 12 haemodialysis hours per week respectively, predominantly delivered as three sessions per week. Ninety-five participants underwent cardiac magnetic resonance imaging (MRI) at baseline and 12 months. Predictors of change in LVMI were examined by multivariable linear regression in an observational analysis.

Results

In the overall MRI cohort, the change from baseline to 12 months in LVMI was -6.7g (95% confidence interval (CI) -11.2, -2.2; P=0.004) with non-significant reductions in mean normalised sessional ultrafiltration rate -1.0mL/kg/hr (95%CI -2.2, 0.24; P=0.114) and weekly total ultrafiltration -0.8L (95%CI -0.3, 2.0; P=0.165) and a significant reduction in systolic blood pressure (BP) -5.4mmHg (95%CI -8.8, -2.0; P=0.002). Baseline LVMI (P=0.003) was associated with improved LVMI in univariable analysis and this remained significant in the multivariable analysis (P=0.046). A non-significant improvement in LVMI was observed with longer dialysis vintage (P=0.137). There were no significant associations between changes in ultrafiltration rates and volumes, systolic and diastolic blood pressure, phosphate, and parathyroid hormone and change in LVMI.

Conclusion

Higher baseline LVMI, but not improvements in volume control, blood pressure or biochemical parameters, predicts regression of left ventricular hypertrophy over 12 months. Further study is warranted to identify predictors of change in this important treatment target.

Funding

• Commercial Support – Baxter International