Kidney Week

Abstract: TH-PO320

Low-Cardiac Output State in Children and Young Adults on Maintenance Hemodialysis

Session Information

• Hemodialysis and Frequent Dialysis - 1
  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

• Sadeghiani, Golnaz, Texas Children's Hospital, Houston, Texas, United States

Golnaz Sadeghiani, DO

• Thadani, Sameer, Texas Children's Hospital, Houston, Texas, United States

Sameer Thadani, MD

• Geer, Jessica, Texas Children's Hospital, Houston, Texas, United States

Jessica Geer, NP

• Silos, Christin N., Texas Children's Hospital, Houston, Texas, United States

Christin N. Silos

• Idrovo, Alexandra, The University of Texas Southwestern Medical Center, Dallas, Texas, United States

Alexandra Idrovo, MD

• Bellomo, Rinaldo, Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia

Rinaldo Bellomo, MD, MBBS

• Srivaths, Poyyapakkam, Texas Children's Hospital, Houston, Texas, United States

Poyyapakkam Srivaths, MD, MS

• Akcan Arikan, Ayse, Texas Children's Hospital, Houston, Texas, United States

Ayse Akcan Arikan, MD, FASN

Background

Intermittent hemodialysis (iHD) induces circulatory strain and impairs myocardial dynamics. Maturing cardiovascular system in children may create an additional risk for iHD induced myocardial dysfunction. We used continuous electrocardiometry to measure cardiac index (CI) and stroke volume index (SVI) in children on maintenance iHD.

Methods

Prospective observational study of patients <21 years on 3/week 4-hour maintenance iHD at Texas Children Hospital. We collected hemodynamic data (CI, SVI) with ICON (Berlin Germany Ospky medical) during the first treatment of the week. Baseline CI and SVI were measured at the initiation of iHD and continuously thereafter for 240 minutes.

Results

14 patients with median iHD vintage 14 months (9-24) were included. The median ultrafiltration rate was 10ml/kg/hr (6-13) The baseline CI was 3.37 +/- 0.69 L/min/m² while the nadir CI was 2.60 +/-0.48 L/min/m². 3 (21%) patients had a baseline CI <3L/min/m². CI decreased in the majority of patients (13/14, 93%). The mean change in CI was - 21%+/- 14% (Figure 1). The baseline SVI was 39.7 +/- 7.3 ml/m² and the nadir SVI was 29.7 +/- 5.4 mL/m². SVI decreased by 23% +/- 15% (Figure 2) . 7 (50%) patients developed a low cardiac output state (CI<2.5).

Conclusion

Asymptomatic children and young adults on maintenance iHD experience >20% decrease in CI and SVI. Despite fewer cardiovascular comorbidities than their adult counterparts, iHD can induce myocardial dysfunction in children. Association of these cardiovascular changes with markers of other end organ injury should be further investigated.