P223 BENEFICIAL EFFECT OF ACEI/ARB, BETABLOCKER AND MINERALOCORTICOID RECEPTOR ANTAGONIST IN PATIENTS WITH RECURRENT FLASH PULMONARY EDEMA INITIATED ON HEMODIALYSIS FOR END STAGE RENAL FAILURE

Background and Objectives: Recurrent flash pulmonary edema is a rare manifestation of ESRF commencing hemodialysis, necessitating more frequent dialysis. Recurrent flash pulmonary edema is seen in renal artery stenosis and rarely in chronic kidney disease. Objective of the study is look for any possible contributory factors for recurrent flash pulmonary edema in patients with ESRF initiated on hemodialysis; and the potential role of ACEI/ARB, β blockers and MRA in controlling episodes of flash pulmonary edema. Methods: All patients initiated on hemodialysis from January 2020 to December 2023 were studied in detail; including ECHO cardiography and renal ultrasound doppler. Patient were divided in to 2 groups based on absence or presence of recurrent flash pulmonary edema (Group A and Group B).Group B further divided in to Group C and D. Group C were treated with ACEI/ARB, β blocker and MRA in addition to nitroglycerine infusion and hemodialysis. Group D were given usual anti hypertensives nitroglycerine infusion and hemodialysis as per requirement. Group C and D were followed up for 2 months and evaluated for the final out come. Results: 238 patients were initiated on hemodialysis during the period of 3 years. 18 patients (7.56%) presented with recurrent flash pulmonary edema (Group B) and 220 patients (92.44%) comprised Group A. Patients in Group B had more severe LVH, left ventricular diastolic dysfunction (LVDD) PAH and accelerated hypertension. None of the patients had renal artery stenosis. At the end of 2 months patients in Group C (9 patients) were free from recurrent flash pulmonary edema compared to Group D (9 patients) Conclusions: Recurrent flash pulmonary edema is a rare manifestation of ESRF. Renal artery stenosis was not seen in our patients. LVH, LVDD due to uremic cardiomyopathy and accelerated hypertension due to RAAS activation may be the contributory factors. Treatment with ACEI/ARB, β blockers and MRA may help in controlling episodes of flash pulmonary edema.