Abstract: FR-PO366
Diastolic Dysfunction Parameters in Patients with Intradialytic Hypertension
Session Information
- Hypertension, CVD, and the Kidneys: Epidemiology
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Nguyen, Thuylinh M., The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Horvit, Andrew, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Van Buren, Peter N., The University of Texas Southwestern Medical Center, Dallas, Texas, United States
Background
Hypertension and heart failure (HF) are common in hemodialysis (HD) patients, and intradialytic hypertension (IH) further increases mortality risk. We characterized differences in cardiac structure and function in patients with and without IH with a focus on the ratio of mitral inflow velocity (E) to mitral annular early diastolic velocity (e’).
Methods
We conducted a retrospective study of Dallas VA HD patients with available transthoracic echocardiograms (TTE). We calculated intradialytic blood pressure slope (IBPS) for each of 3 treatments before and after the TTE using all intradialytic measurements and defined IH as mean IBPS >0. We compared average E/e’ in patients with and without IH using Mann Whitney U (raw data) and unpaired t test (log transformed data). We used logistic regression with average E/e’ >14 as the primary outcome and IH as the primary predictor
Results
Average E/e’ was 17.1 (15-22) in the IH group (n=19) vs. 14.3 (10-18) in the non-IH group (n=37; p=.02). E/A was 1.18 (0.6) in IH vs. 0.95 (0.3) in non-IH (p=.06). IH patients had lower ejection fraction (EF) (p=.04) but higher left ventricular mass index (LVMI) (p=.007). While controlling for age, diabetes, race, and EF, IH predicted E/e’ >14 (OR 7.1 [1.6-44]); but this was blunted when controlling for LVMI (OR 3.1 [0.5-31)].
Conclusion
Diastolic dysfunction is common in HD patients and is more severe in IH. LVMI may mediate higher E/e’ in IH patients. TTE should be obtained in IH patients to better understand structural and functional abnormalities that may increase CV risk
Patient Characteristics
| No IH (N=37) | IH (N=19) | P- Value | |
| Age (years) | 65.4 (9.4) | 68.1 (9.8) | 0.3 |
| Diabetes | 29 (78%) | 10 (53%) | 0.07 |
| Mean IBPS | -3.48 (-6.1,-1.87) | +1.11 (0.5-2.1) | <0.0001 |
| EF (Non-Teicholz) % | 55.6 (9.9) | 48.1 (17) | 0.04 |
| Systolic Dysfunction | 7 (19%) | 9 (47%) | 0.03 |
| Diastolic Dysfunction | 25 (89%) | 16 (100%) | 0.03 |
| LVMI (N= 44;g/m2) | 108 (37) | 142 (40) | 0.007 |
| E/A (n=53) | 0.95 (0.3) | 1.18 (0.6) | 0.06 |
| Average E/e | 14.3 (9.9-18) | 17.1 (15-22) | 0.02 |
Funding
- NIDDK Support