ESPN 54th Annual Meeting

ESPN 2022


 
HIGHER RELATIVE OVERHYDRATION BLUNTS AUGMENTATION INDEX IN CHILDREN ON DIALYSIS
Stella Stabouli 1 Varvara Askiti 2 Athanasia Chainoglou 1 Georgia Malakasioti 2 Vasiliki Karava 1 Maria Mila 2 Katerina Chrysaidou 1 Smaragdi Marinaki 3 Andromachi Mitsioni 2

1- First Pediatric Department, Medical School, Faculty of Health Sciences, Aristotle University Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
2- Nephrology Department, “P&A Kyriakou” Children’s Hospital, Athens, Greece
3- Clinic of Nephrology and Renal Transplantation, National and Kapodistrian University of Athens, Medical School, Athens, Greece
 
Introduction:

Cardiovascular disease is highly prevalent in the chronic kidney disease population and associates with higher morbidity and mortality even in young ages. The aim of the present study was to assess the effect of hydration status on ambulatory blood pressure monitoring (ABPM) and pulse wave analysis (PWA) profiles in children on dialysis.

Material and methods:

Sixteen patients on peritoneal dialysis (PD) and 12 patients on hemodialysis (HD) with similar age, underwent ABPM, PWA, echocardiography and assessment of hydration status calculating relative overhydration (rel-OH, %) by bioimpedance spectroscopy. 

Results:

Mean age of the cohort was 12.07±3.242 years. Rel-OH was higher in PD patients compared to HD (6.56±6.43 vs -2.57±6.67 %, p<0.005). Rel-OH did not differ between anuric patients and those with residual kidney function. Na intake was not associated with BP and PWA parameters, neither with rel-OH. We found no significant associations of rel-OH with MAP, central SBP, neither with pulse wave velocity (PWV), cardiac index (CI), and left ventricular mass index (LVMI). However, there was a negative association between heart rate-adjusted augmentation index (AIx75) and rel-OH levels (r=-0.36, p<0.05). The differences in AIx75 between those with normal rel-OH (-7 to 7%) and rel-OH > 7% persisted after adjustment for age, sex, MAP, central SBP, PWV, and dialysis modality (29.15, 95%CI 26.9-31.3 vs 22.25, 95%CI 17.9-26.59 %, respectively, p<0.05). In HD patients we also found no association between interdialytic weight gain (IDWG) % and MAP, central SBP, AIx75, CI, PWV and LVMI. CI was numerically higher in those with IDWG > 4% but the difference was not significant.

Conclusions:

In children on dialysis volume overload may blunt the impact of reflecting waves in the pulse wave contour masking functional vascular abnormalities and resulting in lower AIx75 independent of BP and PWV levels. The significance of IDWG versus chronic volume overload needs further research.