ESPN 51th Annual Meeting

ESPN 2018


 
Interdialytic weight gain and uremic vasculopathy in children on hemodialysis: a single center study
VASILIKI KARAVA 1 CHERINE BENZOUID 2 THERESA KWON 1 MARIE-ALICE MACHER 1 GEORGES DESCHENES 1 JULIEN HOGAN 1

1- SERVICE DE NEPHROLOGIE PEDIATRIQUE, HOPITAL ROBERT DEBRE, APHP, PARIS, FRANCE
2- SERVICE DE CARDIOLOGIE PEDIATRIQUE, HOPITAL ROBERT DEBRE, APHP, PARIS, FRANCE
 
Introduction:

Increased interdialytic weight gain (IDWG) has been associated with poor outcomes in adults, but its impact on uremic vasculopathy in hemodialyzed children is unknown.

Material and methods:

Nineteen patients (age 9 to 19 years old) with a median hemodialysis duration of 10.4 months were enrolled. Cardiovascular evaluation included left ventricular mass index (LVMI), pulse wave velocity (PWV) and carotid intima-media thickness (cIMT) measurements. Patients were classified according to percentile reference values of these parameters in healthy children. Blood pressure (BP) evaluation included non-invasive measurement of central BP and 24 hour ambulatory BP monitoring. Mean IDGW and mean residual urine output during the 6 months prior to cardiovascular examination were calculated.

Results:

Increased cIMT, LVMI and PWV was observed in 11 (57.9%), 7 (36.8%) and 5 (26.3%) patients respectively. BP evaluation was normal in all patients. Median IDWG was 3.5% (1.8-6.7). Distribution of residual urine output, antihypertensive medication, high LVMI and high PWV was not statistically different between patients with IDWG≥ or <4%. Linear correlation was observed between IDWG and cIMT (r²=0.458, p=0.001), but not between IDWG and PWV (r²=0.011, p=0.671). After univariate logistic regression, IDWG≥4% was significantly associated to increased cIMT (odds ratio 12.25, 95% confidence interval 1.08-138.99). The trend towards an increased cIMT with IDWG≥4% was observed in both patients with short and long dialysis vintage.

Conclusions:

High IDWG is associated with increased cIMT in hemodialyzed children independently of BP control and dialysis vintage. This observation reinforces the importance of interventions to avoid increased IDWG in children on hemodialysis.