Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Patients (pts) with end stage renal disease have a high morbidity and mortality rate, mostly due to cardiovascular events (CV). Transplantation (Tx) improves survival compared to those patients on a waiting list. There is no evidence on how hemodynamic and autonomic parameters behave after renal Tx (RTx). We aim to describe the differences in CV parameters between pts undergoing chronic dialysis (Dx) and those who underwent RTx. OBJECTIVES: 1. We studied the potential hemodynamic and autonomic differences between dialysis patients (Dx) and renal Tx patients (RTx). 2. We analyzed if there were hemodynamic and autonomic differences in terms of glomerular filtration rate (GFR) in RTx patients versus Dx patients.
*Methods: 285 subjects were enrolled in a CV evaluation program including Dx pts (PRECADIA) and RTx pts (PRECATE) at CEMIC. They underwent non-invasive hemodynamic determination by impedance cardiography (Equipment Z logic-Exxer SA) taking into account the following variables: stroke volume (SV), heart rate (HR), systemic vascular resistance index (SVRI), arterial compliance index (ACI) and thoracic fluid content (TFC). Dx patients were analysed at the inter-Dx day. HR variability was assessed (Kubios, Finland) for 3 minutes at rest, with measurement of the spectral components: high frequency (HF), low frequency (LF), very low frequency, LF / HF and total power (totpower). The exclusion criteria were: incomplete hemodynamic analysis, time in Dx or Tx less than 6 months, and amputation. RTx pts were classified into quartiles (Q) according to estimated FG (FGe) by CKD-EPI, (Q1 31 ± 7.5 ml/min, Q2 47.1 ± 3ml/min, Q3 59.2 ± 4ml/min, Q4 83 ± 12min/ml), were compared among each other, and to Dx pts. The comparison between the 5 groups was performed using ANOVA.
*Results: We included 254 patients (142 in Dx and 112 RTx). No significant differences were detected in terms of age, sex, BMI, DBT and antihypertensive treatment. In the initial hemodynamic analysis, SV was significantly higher in Q2-Q4 groups vs Q1 and Dx (p 0.005), higher ACI in Q2-Q4 vs Q1 and Dx (p 0.001). Regarding SVRI, Q1 and Dx were significantly higher than the other Qs.From the autonomous point of view, RTx pts presented a higher HR variability (p 0.028), higher LF variability (p 0.002) and higher VLF (p 0.019), in addition to higher totpower specifically for patients in Dx, which was statistically significant (p=0.009). Same trend was observed when comparing Qs with each other.
*Conclusions: The recovery of renal function after RTx, with eGFR greater than 35ml/min, was associated with a significant improvement of hemodynamic and autonomic parameters.
To cite this abstract in AMA style:Sleiman J, Castellaro C, Laham G, Schiavone M, Biain M, Brukman L, Pujol GSoler, Diaz C. Determinants of Cardiovascular Benefit Observed in a Population with a Functioning Renal Transplant versus Patients Undergoing Chronic Dialysis [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/determinants-of-cardiovascular-benefit-observed-in-a-population-with-a-functioning-renal-transplant-versus-patients-undergoing-chronic-dialysis/. Accessed May 8, 2021.
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