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Vascular calcification and cardiac function according to residual renal function in patients on hemodialysis with

Dong Ho Shin¹, Young-Ki Lee², Jieun Oh¹

¹Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.

|September 28, 2017

Insights

Residual renal function in hemodialysis patients is linked to reduced vascular calcification and better cardiac function. Maintaining residual renal function may improve cardiovascular outcomes in ESRD patients.

Area of Science:

Nephrology
Cardiology
Vascular Biology

Background:

Vascular calcification and cardiac dysfunction are prevalent in end-stage renal disease (ESRD) patients undergoing hemodialysis.
The impact of residual renal function on these complications remains unclear.

Purpose of the Study:

To investigate the association between residual renal function and vascular calcification in hemodialysis patients.
To examine the relationship between residual renal function and cardiac function, specifically left ventricular diastolic dysfunction.

Main Methods:

106 hemodialysis patients with residual renal function were studied over three years.
Residual renal urea clearance (KRU) measured residual renal function.
Abdominal aortic calcification score (AACS), brachial-ankle pulse wave velocity (baPWV), and echocardiography assessed vascular and cardiac status.

Main Results:

Lower residual renal function (KRU < 0.9 mL/min/1.73m²) correlated with higher AACS and baPWV.
Reduced KRU was significantly associated with left ventricular diastolic dysfunction.
Patients with lower KRU showed a trend towards more cardiovascular events.

Conclusions:

Residual renal function is significantly associated with vascular calcification in hemodialysis patients.
Preserved residual renal function is linked to better cardiac function, specifically reduced left ventricular diastolic dysfunction.

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Abstract

Background:

Vascular calcification is common and may affect cardiac function in patients with end-stage renal disease (ESRD). However, little is known about the effect of residual renal function on vascular calcification and cardiac function in patients on hemodialysis.

Methods:

This study was conducted between January 2014 and January 2017. One hundred six patients with residual renal function on maintenance hemodialysis for 3 months were recruited. We used residual renal urea clearance (KRU) to measure residual renal function. First, abdominal aortic calcification score (AACS) and brachial-ankle pulse wave velocity (baPWV) were measured in patients on hemodialysis. Second, we performed echocardiography and investigated new cardiovascular events after study enrollment.

Results:

The median KRU was 0.9 (0.3-2.5) mL/min/1.73m2. AACS (4.0 [1.0-10.0] vs. 3.0 [0.0-8.0], p = 0.05) and baPWV (1836.1 ± 250.4 vs. 1676.8 ± 311.0 cm/s, p = 0.01) were significantly higher in patients with a KRU < 0.9 mL/min/1.73m2 than a KRU ≥ 0.9 mL/min/1.73m2. Log-KRU significantly negatively correlated with log-AACS (ß = -0.29, p = 0.002) and baPWV (ß = -0.19, P = 0.05) after factor adjustment. The proportion of left ventricular diastolic dysfunction was significantly higher in patients with a KRU < 0.9 mL/min/1.73m2 than with a KRU ≥ 0.9 mL/min/1.73m2 (67.9% vs. 49.1%, p = 0.05). Patients with a KRU < 0.9 mL/min/1.73m2 showed a higher tendency of cumulative cardiovascular events compared to those with a KRU ≥ 0.9 ml/min/1.73m2 (P = 0.08).

Conclusions:

Residual renal function was significantly associated with vascular calcification and left ventricular diastolic dysfunction in patients on hemodialysis.

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