Abstract: SA-PO353
Estimated Dry Weight: The Elusive Target
Session Information
- Hemodialysis and Frequent Dialysis: CV and Risk Prediction
November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Gatiba, Juliet, Hennepin Healthcare, Minneapolis, Minnesota, United States
- Alsayed, Momen, Hennepin Healthcare, Minneapolis, Minnesota, United States
Introduction
Volume assessment and management in end stage kidney disease (ESKD) has been shown to have a significant effect on intradialytic morbidity and long-term cardiovascular complication. In this report, we hope to elucidate the effects of volume management on cardiac function in dialysis patients and the importance of non-invasive imaging in volume assessment.
Case Description
A 40-year-old female with a history of ESKD on dialysis and heart failure with reduced ejection fraction of 45-50%, as well as other comorbidity was admitted for optimization of volume status prior to arteriovenous graft placement. She had been consistently above her estimated dry weight (EDW) of 52 kg and had failed outpatient volume optimization. On admission, she weighed 56 kg. She underwent hemodialysis on hospital days 1 and 2, with a total of 8 kg of ultrafiltration. Her weight decreased to 51.4kg. After achieving her EDW, a dobutamine stress echocardiogram done on day 3, showed severe biventricular systolic dysfunction with an ejection fraction of 27%. Cardiology evaluated the patient and recommended continued volume optimization followed by coronary angiography to evaluate for underlying coronary artery disease. She had 3 additional days of ultrafiltration of 10kg. Her weight decreased to 46.5kg. A repeat transthoracic echocardiogram on day 5, showed significant improvement in cardiac function as shown in Table 1. Coronary angiogram was deferred, and an arteriovenous graft was placed.
Discussion
This case reinforces the importance of assessing volume status in patients with ESKD on dialysis with underlying heart failure with reduced ejection fraction. It specifically points out the importance of using non-invasive imaging like transthoracic echocardiograms rather than solely depending on clinical picture and EDW for volume assessment. It also highlights how volume management can mitigate an elemental constituent of mortality in renal patients, cardiac function, and recovering ejection fraction with ultrafiltration.
Table 1
| Dobutamine Echo (Hospital day 3) | TTE (Hospital Day 5) | |
| Left ventricular EF | 27% | 50% |
| Right ventricular EF | Severely decreased | Normal |
| Estimated RA pressure | 17mmHg | 13mmHg |
| Tricuspid valve insufficiency | 3+ to 4+ | 1+ |