#3645 Clinical and echocardiographic profile of patients initiating unplanned haemodialysis due to cardiorenal syndrome

Abstract Background and Aims Cardiovascular disease, particularly cardiorenal syndrome (CRS) is a strong determinant of access-related and patient-related outcomes. This study aims to characterize the profile of patients requiring unplanned haemodialysis (uHD) initiation due to CRS and clinical predictors of mortality. Method A retrospective analysis of the patients who initiated uHD due to CRS at our center in 2022–2023 was performed. Demographic, echocardiographic and access-related data, and 1-year outcomes were collected from their health records. CRS cases were classified by two independent authors. The primary outcome was to characterize this subset of patients and the secondary aim was to identify clinical predictors of 1-year mortality. Statistical analysis was conducted with SPSS v28.0.1. Results Of the 184 patients requiring uHD, 57 were due to CRS, with a majority being male (68.4%). The mean age was 74.8 (±9.7) years and the median (IQR) Charlson Comorbidity Index (CCI) was 7 (6–8). All patients had a history of heart failure (HF) and chronic kidney disease (CKD). Regarding HF, the most common etiology was ischemic (47.4%) and the median NYHA score was 1. Thirty-one patients (54.4%) had moderate to severe valvulopathies-particularly tricuspid and mitral regurgitations; 12 (23.5%) had diastolic dysfunction [mitral E/e´ >10]; 17 (29.8%) had reduced left ventricular ejection fraction [LVEF <40%]; and 10 (17.5%) right ventricular dysfunction [TAPSE <17mm]. Regarding CKD, the most common etiology was diabetes (40.4%) and the dominant nephrological syndrome was acutely decompensated CKD (71.9%). Forty-six (80.7%) patients had a prior nephrology appointment and 7 (12.3%) had a kidney transplant. At HD initiation, median sCr was 4.91 mg/dL (Δ +1.44 from baseline), BNP was 1272 pg/mL (Δ +571) and Hgb was 9.0 g/dL (Δ −1.3). Two-thirds started HD with a central venous catheter. Within one year, 16 (28.1%) patients died,—mostly due to MACE (8 patients). This was significantly higher when compared to non-CRS uHD patients (vs 15.0%, P = 0.036). One patient recovered kidney function (1.8%). No access-related variables, comorbidities or echocardiographic features per si were predictors of 1-year mortality. Conclusion Patients requiring uHD due to CRS are highly comorbid and face significantly higher mortality compared to non-CRS patients. Our analysis did not find specific clinical or echocardiographic predictors of 1-year mortality.