SaO019LUNG ULTRASOUND GUIDED DRY-WEIGHT PROBING REDUCES CARDIAC CHAMBERS DIMENSIONS AND LEFT VENTRICULAR FILLING PRESSURES IN HEMODIALYSIS PATIENTS WITH HYPERTENSION

Abstract

INTRODUCTION: Left (LV) and right (RV) ventricular diastolic dysfunction is highly prevalent in hemodialysis patients (50%‐75%). Hypertension and increased preload due to hypervolemia are major factors for the pathogenesis of ventricular dilatation and dysfunction in these patients. This study examined the effect of lung‐ultrasoundguided dry‐weight reduction on echocardiographic indices of left and right cardiac size, systolic and diastolic function in hypertensive hemodialysis patients. METHODS: This is a single‐blind randomized clinical trial in 71 hemodialysis patients with hypertension that were clinically euvolemic. Patients were randomized in the active group (n=35), following a strategy for dry‐weight reduction guided by the total number of US‐B lines (US‐B lines score) prior to a mid‐week dialysis session and the control group (n=36), following standard‐of‐care treatment. All patients underwent two‐dimensional echocardiographic and tissue‐Doppler imaging (TDI) studies at baseline and after 8‐weeks. RESULTS: Overall, 19 (54.3%) patients in the active and 5 (13.9%) in the control group had UF intensification (p<0.001) during follow‐up (dry‐weight changes: ‐ 0.71±1.39 vs +0.51±0.98 kg, p<0.001), which resulted in higher US‐B lines changes in the active group (‐5.3±12.5 vs +2.2±7.6, p<0.001). Reductions in LA and RA sizing parameters were significantly higher in the active group (LA Surface: ‐1.09±4.61 vs 0.93±3.06 cm2, p=0.034; RA surface: ‐1.56±6.17 vs 0.47±2.31 p=0.024; LAVi: ‐ 2.43±13.14 vs 2.95±9.42 ml/m2, p=0.052). Reductions in LV end‐diastolic diameter and volume were marginally higher in the active group. Similarly, LV filling pressures significantly decreased in the active compared to the control group (E/E' LV: ‐ 0.38±3.14 vs 1.36±3.54, p=0.034; DT: 35.43±85.25 vs ‐18.44±50.69, p=0.002). In general, cardiac systolic function indices were unchanged from baseline to study‐end in both groups. Inferior vena cava diameter (mm) was lower after 8‐weeks in the active compared to the control group (10.32±3.91 vs 12.58±4.64 mm, p=0.029). CONCLUSIONS: A lung‐ultrasound‐guided strategy for dry‐weight reduction can effectively reduce cardiac chambers dimensions and LV filling pressures without changing systolic performance during an 8‐week follow‐up in hypertensive hemodialysis patients.