SP541EFFECT OF DIFFERENT DIALYSIS MODALITIES ON RIGHT VENTRICULAR DYSFUNCTION IN PATIENTS WITH END-STAGE RENAL DISEASE

Abstract

Introduction and Aims: While patient with dialysis therapy has a high prevalence of pulmonary hypertension, right heart failure during dialysis treatment is associated with increased mortality in patients with pulmonary hypertension. We investigated the effects of different dialysis modalities on right ventricular dysfunction (RVD) in stage 5 CKD (chronic kidney disease) patients and the risk factors of RVD. Methods: A total of 137 patients with end-stage renal disease (ESRD) on regular maintenance dialysis were included in this cross-sectional study and were allocated into 3 groups according to the dialysis modalities: continuous ambulatory peritoneal dialysis (CAPD; n = 37), hemodialysis (HD) with central venous catheters (CVC; n = 30), and HD with arteriovenous fistula (AVF; n = 70). Tissue Doppler imaging (TDI) of echocardiography was performed to investigate the right ventricular function in all patients. Pearson linear correlation analysis was used to check the relevance of RVD and pulmonary hypertension; Logistic regression analysis was performed to analysis the risk factors of right ventricular dysfunction. Results: Systolic pulmonary artery pressure (sPAP) progressively rose from CAPD patients to HD patients with CVC and AVF. The presence of pulmonary hypertension were 8.82%, 31.57%, and 37.31% respectively ( p<0.001). RVD, assessed by TDI MPI, was more common in HD patients compared with CAPD patients, and was more pronounced in HD patients with AVF. The prevalence of RVD were 44.78%, 68.42%, and 87.23% respectively (p<0.001). Moreover, the percentage of right ventricular hypertrophy significantly increased in HD patients with AVF, when comparing with HD with CVC and PD patients. Univariate analysis showed, sPAP was positive correlated with MPI (r=0.283,p=0.019) and RV wall thickness (r=0.514,p<0.001). The multivariate determinants of RVD were Kt/V [odds ratio 0.59, 95% confidence interval (CI) 0.17-0.98, p = 0. 041] and sPAP (odds ratio 2.85 per mmHg, 95% CI 1.39-4.37, p = 0. 014) when adjusted for age, BMI and heart rate. Conclusions: Compared with CAPD patients, right ventricular abnormalities and right ventricular hypertrophy was more common in patients on HD and particularly those with an arterioveinous fistula. The insufficient dialysis treatment and pulmonary hypertension may play pivotal roles in the development of RVD.