ESPN 54th Annual Meeting

ESPN 2022


 
Predictors of poor cardiovascular status in pediatric hemodialysis patients – Results from the International Pediatric Hemodialysis Network IPHN
DAGMARA BORZYCH-DUZALKA 1 RUKSHANA SHROFF 2 SARA TESTA 3 MARC FILA 4 AYSUN AYSUN BAYAZIT 5 GEMA ARICETA 6 ATTILA SZABO 7 AMRIT KAUR 8 STéPHANIE TELLIER 9 ISABELLE VRILLON 10 LOAI EID 11 YAM-NGO LIM 12 JAMEELA KARI 13 MARSHA LEE 14 BRADLEY A WARADY 15 FRANZ SCHAEFER 16 CLAUS PETER SCHMITT 16

1- MEDICAL UNIVERSITY OF GDANSK, GDANSK, POLAND
2- GREAT ORMOND STREET HOSPITAL FOR CHILDREN, LONDON, UK
3- FONDAZIONE OSPEDALE MAGGIORE POLICLINICO, MILANO, ITALY
4- CHU DE MONTPELLIER, MONTPELLIER, FRANCE
5- CUKUROVA UNIVERSITY, FACULTY OF MEDICINE, ADANA, TURKEY
6- HOSPITAL UNIVERSITARIO MATERNO-INFANTIL VALL D HEBRON, BARCELONA, SPAIN
7- SEMMELWEIS UNIVERSITY, BUDAPEST, HUNGARY
8- ROYAL MANCHESTER CHILDREN HOSPITAL, MANCHESTER, UK
9- DIALYSE PéDIATRIQUE CHU TOULOUSE, TOULOUSE, FRANCE
10- CHRU NANCY, NANCY, FRANCE
11- DUBAI HOSPITAL, DUBAI, UNITED ARAB EMIRATES
12- KUALA LUMPUR HOSPITAL, KUALA LUMPUR, MALAYSIA
13- KING ABDULAZIZ UNIVERSITY HOSPITAL, JEDDAH, SAUDI ARABIA
14- THE UNIVERSITY OF CALIFORNIA, SAN FRANCISCO (UCSF), SAN FRANCISCO, USA
15- CHILDRENS MERCY HOSPITAL, KANSAS CITY, USA
16- CENTER FOR PEDIATRICS AND ADOLESCENT MEDICINE, HEIDELBERG, GERMANY
 
Introduction:

Fluid and salt overload in dialysis patients result in high blood pressure (BP), left ventricular hypertrophy (LVH) and are associated with poor outcome. 

Material and methods:

954 pediatric hemodialysis (HD) patients (542M/412F), aged 0 to 21 (median 12) years on chronic HD(F), treated at 65 pediatric dialysis units in 30 countries were prospectively followed by the IPHN.

Results:

In 2838 6-monthly observations 28% of patients were normotensive without antihypertensives, while 17% were normotensive on 2.1±1.0 antihypertensives and  55% patients were hypertensive. 24% of HD and 33% of HDF patients were normotensive without treatment (p<0.001). Systolic BP-SDS was independently predicted (PE±SEM) by intradialytic weight gain (IDWG; 0.2±0.02, p=0.0006) and younger age (-0.08±0.01, p<0.0001). Diastolic BP-SDS was predicted by younger age (-0.08±0.007, p<0.0001), dialysate sodium (0.05±0.01; p=0.006) and dialysis modality (HD versus HDF; PE 0.2±0.08; p=0.02). 4% of systolic and 12% of diastolic BP variability was explained by center effects. 

Median LV mass index (LVMI) was 41.3 (31.6; 54.4); 51% patients exhibited LVH. In multivariable analysis LVMI was predicted by higher systolic BP-SDS (2.8±0.55, p<0.0001), younger age (-1.15±0.18; p<0.0001) and dialysis modality (HD versus HDF; 5.8±2.03; p=0.004), but not by UF/h, urine output/m2 or dialysate sodium. 

Intradialytic hypotension was reported in 23% of dialysis sessions and independently predicted by HD mode (0.54±0.2, p=0.007), lower urine output/m2 (-0.44±0.16, p=0.005), higher IDWG (0.14±0.04, p=0.0001) and younger age (-0.05±0.002, p=0.008), but not by dialysate sodium, BP, UF/h and weekly dialysis time.  13% of the variability was explained by center effect.

Conclusions:

High blood pressure is still prevalent in the majority of hemodialysis patients despite elaborated antihypertensive therapy. Predictive and modifiable factors of BP and LVH include, dialysis modality, dialysate sodium and IDWG. HDF is superior to HD in terms of BP control, prevention of LVH and intradialytic hypotension, independent of center effects.