Kidney Week

Abstract: SA-PO582

Comparative Analysis of Cardiovascular Performance in Hemodialysis and Heart Failure Patients

Session Information

• Hemodialysis: Biomarkers, Translational Research
  November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Kamran, Hayaan, Indiana University School of Medicine, Indianapolis, Indiana, United States

Hayaan Kamran,

• Arroyo, Eliott, Indiana University School of Medicine, Indianapolis, Indiana, United States

Eliott Arroyo,

• Dillman, Drake, Indiana University School of Medicine, Indianapolis, Indiana, United States

Drake Dillman,

• Moe, Sharon M., Indiana University School of Medicine, Indianapolis, Indiana, United States

Sharon M. Moe,

• Lim, Kenneth, Indiana University School of Medicine, Indianapolis, Indiana, United States

Kenneth Lim,

Background

Patients on hemodialysis (HD) exhibit significant impairment in cardiovascular functional capacity that may be comparable to those with non-CKD associated heart failure. The problem is that to-date, no studies have directly compared cardiovascular functional differences between patients on HD compared with non HD patients with heart failure with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). We hypothesized that patients on HD exhibit unique exercise ventilatory response patterns compared to those with HFrEF and HFpEF.

Methods

We conducted a cross-sectional analysis of patients on thrice-weekly HD versus HFpEF (EF ≥40%) and HFrEF (EF <40%) patients who underwent cardiopulmonary exercise test (CPET) at Indiana Universtiy. A total of 90 patients (age=55 [13] years; n=30 per group) were included in this analysis.

Results

There were no group differences in age, sex, or diabetes (all p’s>0.05). The HD group had a higher prevalence of hypertension (p<0.001), lower hemoglobin (Hgb; p<0.001), and lower beta blocker (BB) use (p<0.001) compared to both HFrEF and HFpEF, and a higher proportion of smokers compared to the HFpEF group (p=0.017). After adjusting for these covariates, peak oxygen uptake (VO₂Peak) was lower in the HD (12.9 [12.0-14.1] mL/kg/min) and HFrEF (13.0 [12.2-14.3] mL/kg/min) groups compared to HFpEF (16.3 [15.5-17.6] mL/kg/min; p=0.028). Percent of heart rate reserve (% HRR) was lower in the HD group (37.8 [31.6-39.8]; p=0.011) compared to both HFrEF (57.0 [20.9-59.1]) and HFpEF (61.0 [54.8-63.0]). Additionally, VE/VCO₂ slope was lowest in the HD group compared to HFpEF and HFrEF (p<0.001). Hgb, smoking, VE/VCO₂ slope, and %HRR were significantly associated with VO₂Peak in the HD group; this differered with sex, race, VE/VCO₂ slope, and %HRR for HFrEF, and sex, BB use, and %HRR for HFpEF.

Conclusion

Patients on HD exhibit similar declines in VO₂Peak as those with HFrEF without significant CKD undergoing evaluation for heart transplant, exemplifying the dramatic effects of CKD on cardiovascular health. Chronotropic incompetence and impaired skeletal muscle reserve may be predominant drivers of impaired VO₂Peak in HD patients, while impaired lung capacity and cardiac output may be predominant drivers in patients with HFrEF and HFpEF.