Abstract: TH-PO221
Clinical Impact of Diastolic Dysfunction in ESKD
Session Information
- Hypertension and CVD: Clinical - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Jeon, Hojin, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
- Lee, Kyungho, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
- Jeon, Junseok, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
- Lee, Jung eun, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
- Huh, Wooseong, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
- Kim, Yoon-Goo, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
- Jang, Hye Ryoun, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
Background
Diastolic dysfunction with left ventricular hypertrophy and myocardial fibrosis is an important characteristic of uremic cardiomyopathy (UCM) in end-stage kidney disease (ESKD). We investigated clinical courses and risk factors of mortality and major adverse cardiac event (MACE) in ESKD patients starting kidney replacement therapy (KRT) according to the grade of diastolic dysfunction.
Methods
A total of 1038 patients who underwent surgery for vascular or peritoneal access and started KRT between 2010 and 2020 were enrolled. We classified patients according to the diastolic dysfunction grade (DDG) evaluated by echocardiography. Patients with atrial fibrillation (AF) were classified separately. The primary outcome was a composite outcome of all-cause mortality and MACE.
Results
The median age was 62 years, and 662 patients (63.78%) were male. Patients were divided into six groups based on the pre-KRT echocardiography: normal (n=280), DDG 1 (n=149), DDG 2 (n=192), DDG 3 (n=23), DDG undetermined (n=338), and AF (n=56). All-cause mortality and the incidence of MACE were significantly higher in pre-KRT DDG 1 and AF groups (P<0.01). However, after adjusting for age and underlying ischemic heart disease (IHD) at the initiation of KRT, pre-KRT diastolic dysfunction or AF did not affect to mortality and MACE (P=0.75). Furthermore, post-KRT echocardiography was performed at least 6 months after starting KRT, and the patients were regrouped: post-KRT normal (n=132), DDG 1 (n=311), DDG 2 (n=168), DDG 3 (n=23), DDG undetermined (n=303), and AF (n=101). Patients with post-KRT normal diastolic function showed better survival compared to patients with diastolic dysfunction or AF (P<0.01). In a multivariable analysis including post-KRT echocardiographic parameters, post-KRT DDG 2 (HR 2.61, 95% CI 1.08 – 6.30, P=0.03) and post-KRT AF (HR 3.20, 95% CI 1.26 – 8.12, P=0.01) were identified as significant risk factors for all-cause mortality and MACE. Low left ventricle ejection fraction after KRT was associated with increased risk of mortality and MACE (HR 0.98, 95% CI 0.97 – 0.99, P<0.01).
Conclusion
Age and IHD were more important prognostic factors compared to pre-KRT diastolic dysfunction. However, post-KRT echocardiographic findings, including diastolic dysfunction, and AF could be considered as prognostic markers in ESKD patients.