Abstract: TH-PO245
Changes in Coronary Artery Calcification Score in ESKD: Comparison of Hemodialysis and Online Hemodiafiltration
Session Information
- Hemodialysis, Hemodiafiltration, and Frequent Dialysis
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Doi, Toshiki, Iryo Hojin Ichiyokai Harada Byoin, Hiroshima, Japan
- Morii, Kenichi, Iryo Hojin Ichiyokai Harada Byoin, Hiroshima, Japan
- Okubo, Aiko, Iryo Hojin Ichiyokai Harada Byoin, Hiroshima, Japan
- Mizuiri, Sonoo, Iryo Hojin Ichiyokai Harada Byoin, Hiroshima, Japan
- Nishizawa, Yoshiko, Iryo Hojin Ichiyokai Harada Byoin, Hiroshima, Japan
- Masaki, Takao, Hiroshima Daigaku Byoin, Hiroshima, Hiroshima, Japan
Background
It has been shown that high-dose hemodiafiltration (OHDF) reduces the risk of all-cause mortality compared to conventional high-flux hemodialysis (HD) (N Engl J Med. 389: 700, 2023). The primary reason for this reduction was a decrease in infections. Still, there are also many reports that OHDF reduces the risk of cardiovascular death, a significant cause of mortality in dialysis patients, compared to HD (Nephrol Dial Transplant. 31: 978, 2016) (Cochrane Database Syst Rev. 2015: CD006258, 2015).
The coronary artery calcification score (CACS), measured by multi-slice CT, has significant evidence linking it to cardiovascular events, and its usefulness has been reported in dialysis patients (Clin Exp Nephrol. 8: 54, 2004). In this study, we compared changes in CACS between standard HD treatment and OHDF treatment in maintenance dialysis patients.
Methods
A retrospective cohort study was conducted on hemodialysis patients who underwent CACS evaluation using CT at our institution from January 2018 to February 2021. Patients who did not undergo re-evaluation after one year and those with a logarithmically transformed initial Agatston CACS of less than 100 were excluded. The patients were classified into the HD treatment group and the OHDF treatment group. Propensity score matching was performed based on age, sex, dialysis vintage, presence of diabetes, Ca, P, Mg, TSAT levels, and initial Agatston CACS. The aim was to examine whether there was a difference in the change rate of the Agatston CACS after one year between the HD and OHDF groups. The data were presented as medians and interquartile ranges, and JMP16 was used for analysis. Pearson’s chi-square and Mann-Whitney U tests were used for statistical testing.
Results
Of the 560 patients who underwent CACS evaluation during the study period, 263 were included in the study. Through propensity score matching, 49 patients were selected for each group. No significant differences were observed in the baseline characteristics between the groups. The median increase rate of the Agatston CACS after one year was 15.8% (interquartile range 3.2 - 37.2) in the HD group and 6.6% (0.6 - 17.2) in the OHDF group (p = 0.02).
Conclusion
OHDF may suppress coronary artery calcification compared to HD in patients with end-stage renal disease.