MO883: Cardiorenal Syndrome in Dialysis: Outcomes and Prognosis in Comparison With a Control Population
Authors: Suso Andrea , Mon Mon Carmen , Ortiz Milagros , Onate Alonso Irene , Sanchez Maria , Camacho Rosa , Lentisco Carolina , Cedeño Santiago , Oliet Aniana , Ortega Olimpia , Carlos Herrero Berron Juan 
Published: May 2022

BACKGROUND AND AIMS

The interactions of both organs in Cardiorenal Syndrome (CRS) exacerbate the damage and determine a worse prognosis in these patients [1]. The aim of our study is to compare the development and prognosis of CRS patients compared with control patients.

METHOD: In a retrospective fashion, we assigned 60 patients with CRS who underwent dialysis, and we compared them with a control population of 60 patients without CRS in dialysis. We analyzed baseline characteristics of the patients and the dialysis parameters. Survival rates at 1 and 5 years were determined.

RESULTS

The baseline characteristics were similar between groups. The mean age was 72 ± 9 years in CRS and 68 ± 12 years in the control group. Men were more prevalent in both groups CRS (55%) and control (53%). Charlson's Score was 8 ± 2 points in the CRS group and 7 ± 3 points in the control group. Diabetic nephropathy was the most frequent etiology of end-stage renal disease in CRS patients (37%), followed by nephroangiosclerosis (20%). In the control group, the most common etiologies were nephroangiosclerosis (32%), diabetic (22%) and interstitial nephropathy (11%).

CRS patients had more diabetes mellitus (55% versus 35%; P &lt; 0.05), dyslipidemia (63% versus 38%; P &lt; 0.05), ischemic cardiopathy (50% versus 31%; P &lt; 0.05), atrial fibrillation (66% versus 21%; P &lt; 0.05) and valvular heart disease (27% versus 6%; P &lt; 0.05). There were no differences in hypertension (80% versus 76%; P = 0.58), ictus (31% versus 23%; P = 0.30) and peripheral arterial disease (40% versus 33%; P = 0.44) between groups. CRS patients had more hospitalizations due to heart failure before starting dialysis than the control group (52% versus 1.7%; P &lt; 0.05)

Haemodialysis was the most common technique in both groups CRS (98%) and control (95%). The use of permanent tunneled catheters as definite vascular access was more common in CRS patients (60% versus 26%; P &lt; 0.05). There were no differences in the duration of haemodialysis sessions (252 ± 18 versus 257 ± 23 min),  neither in interdialytic weight gain (2.3 ± 0.7 versus 2.4 ± 0.9 Kg). CRS patients had worse ultrafiltration tolerance with a hypotension rate of 48% in CRS versus 10% in the control group (P &lt; 0.05).

The median time in dialysis was inferior in the CRS group [24 (8–42) versus 61 (26–106) months; P &lt; 0.05] compared with controls and the survival rates at 1 and 5 years were worse in the CRS group (71% versus 93%; P &lt; 0.05) and (15% versus 50%; P &lt; 0.05), respectively.

The main cause of death was the cardiovascular events in both groups (35% versus 20%; P = 0.06). However, tumor as a cause of death was superior in the control group (18% versus 0%; P &lt; 0.05).

CONCLUSION

CRS patients have more cardiovascular risk factors and cardiovascular disease as expected, as well as more hospitalizations caused by heart failure before starting dialysis. They have more frequent use of a permanent tunneled catheter. It could be explained because of worse tolerance to the use of arteriovenous fistula in these patients.

- The survival rates at 1 and 5 years are significantly inferior in the CRS group, which highlights the poor prognosis of these patients [2,3].

- The tumor as a cause of death was superior in the control group due to greater time in dialysis of these patients compared with CRS patients