Abstract: SA-PO874
Time-Integrated Fluid Load (TIFL) Predicts Left Ventricular Mass (LVM) reduction: Results from the Frequent Hemodialysis Network (FHN) Daily 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
- Raimann, Jochen G., Renal Research Institute, New York, New York, United States
- Chan, Christopher T., Toronto General Hospital, Toronto, Ontario, Canada
- Daugirdas, John T., University of Illinois College of Medicine, Chicago, Illinois, United States
- Depner, Thomas A., University of California Davis, Sacramento, California, United States
- Larive, Brett, Cleveland Clinic, Cleveland, Ohio, United States
- Beck, Gerald J., Cleveland Clinic Foundation, Cleveland, Ohio, United States
- Greene, Tom, University of Utah, Salt Lake City, Utah, United States
- Kaysen, George A., University of California Davis, Sacramento, California, United States
- Kliger, Alan S., Yale New Haven Health System, New Haven, Connecticut, United States
- Kotanko, Peter, Renal Research Institute, New York, New York, United States
- Lindsay, Robert M., London Health Sciences Centre, London, Ontario, Canada
- Rocco, Michael V., Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
- Levin, Nathan W., Renal Research Institute, New York, New York, United States
- Trial Group, The FHN, NIDDK, NIH, Bethesda, Maryland, United States
Background
Serum sodium concentrations (SNa) less than 138 mEq/L act as effect modifiers to LVM reduction with increased hemodialysis (HD) frequency. Greater time-integrated fluid overload TIFL (incorporating interdialytic period length and increased fluid intake after Na-positive gradient HD) associates with LVM reduction (FHN Trial Group). We tested the interaction between the treatment effect of increased HD frequency on TIFL and change in LVM in the Daily Trial and evaluated, in the light of the “sick-cell” syndrome as a possible cause of low SNa, predictors of low SNa.
Methods
Treatment effects on LVM were analyzed in subgroups of subjects with a TIFL of ≤3 and >3 L*day. In a second step the interaction of the treatment effect with TIFL was tested using a mixed model. We measured CRP, Pentraxin, ICAM, IL-6 and -10, MCP-1, pre-albumin, TNF-Alpha, MPO at baseline of the FHN Daily Trial and compared between SNa greater or less than 138 mEq/L. Data presented as means and 95% CI.
Results
More frequent daily HD associated with a significant treatment effect on LVM when baseline TIFL was >3 L*day. The treatment effect on LVM showed a borderline significant interaction with TIFL [-5.8 (-15.0 to 3.5) g]. Significantly higher baseline CRP, IL-6, MPO, pre-albumin and pentraxin were found in the low SNa group, the intervention had no effect on inflammatory biomarkers.
Conclusion
Low SNa leads to increases in thirst and fluid intake, increasing TIFL and LVM. Decrease of TIFL by higher HD frequency, results in greater LVM reduction. A positive association between low SNa and inflammatory markers suggests inflammation to cause low SNa level and inflamed patients may benefit most from increased HD frequency.
LVM reduction [in g] as per TIFL
| Daily Trial (N=170) | |
| TIFL <= 3 L*days | -5.6 (-21.5 to 10.44) |
| TIFL > 3 L*days | -26.0 (-39.4 to -12.6) |
Funding
- NIDDK Support