Diastolic Dysfunction Parameters in Patients with Intradialytic Hypertension

Background: Hypertension and heart failure (HF) are common in hemodialysis (HD) patients, and intradialytic hypertension (IH) further increases mortality risk. We characterized differences in cardiac structure and function in patients with and without IH with a focus on the ratio of mitral inflow velocity (E) to mitral annular early diastolic velocity (e’). Methods: We conducted a retrospective study of Dallas VA HD patients with available transthoracic echocardiograms (TTE). We calculated intradialytic blood pressure slope (IBPS) for each of 3 treatments before and after the TTE using all intradialytic measurements and defined IH as mean IBPS >0. We compared average E/e’ in patients with and without IH using Mann Whitney U (raw data) and unpaired t test (log transformed data). We used logistic regression with average E/e’ >14 as the primary outcome and IH as the primary predictor Results: Average E/e’ was 17.1 (15-22) in the IH group (n=19) vs. 14.3 (10-18) in the non-IH group (n=37; p=.02). E/A was 1.18 (0.6) in IH vs. 0.95 (0.3) in non-IH (p=.06). IH patients had lower ejection fraction (EF) (p=.04) but higher left ventricular mass index (LVMI) (p=.007). While controlling for age, diabetes, race, and EF, IH predicted E/e’ >14 (OR 7.1 [1.6-44]); but this was blunted when controlling for LVMI (OR 3.1 [0.5-31)]. Conclusion: Diastolic dysfunction is common in HD patients and is more severe in IH. LVMI may mediate higher E/e’ in IH patients. TTE should be obtained in IH patients to better understand structural and functional abnormalities that may increase CV risk Funding: NIDDK Support, Veterans Affairs SupportPatient Characteristics - No IH (N=37) IH (N=19) P- Value Age (years) 65.4 (9.4) 68.1 (9.8) 0.3 Diabetes 29 (78%) 10 (53%) 0.07 Mean IBPS -3.48 (-6.1,-1.87) +1.11 (0.5-2.1) <0.0001 EF (Non-Teicholz) % 55.6 (9.9) 48.1 (17) 0.04 Systolic Dysfunction 7 (19%) 9 (47%) 0.03 Diastolic Dysfunction 25 (89%) 16 (100%) 0.03 LVMI (N= 44;g/m2) 108 (37) 142 (40) 0.007 E/A (n=53) 0.95 (0.3) 1.18 (0.6) 0.06 Average E/e 14.3 (9.9-18) 17.1 (15-22) 0.02