#6030 CARDIAC ULTRASOUND ASSESSMENT AND THE NOVEL INFLAMMATION, FIBROSIS AND CALCIFICATION BIOMARKERS IN ESKD PATIENTS ON HD THERAPY: A PILOT STUDY
Authors: Schiller Adalbert , Bob Flaviu , Mihaescu Adelina , Chisavu Lazar , Marc Luciana , Schiller Oana-Marina , Lupusoru Raluca , Ivan Viviana 
Published: June 2023

Abstract

Background and Aims
Novel biomarkers for inflammation, fibrosis, and vascular calcification have been recently used for further assessment of cardiovascular risk. The aim of our prospective study is to assess the relation between the novel cardiovascular biomarkers and biomarkers for vascular calcification with cardiac ultrasound function/morphology alteration in high cardiovascular risk patients with end stage kidney disease (ESKD) on haemodialysis (HD) therapy. Baseline findings are discussed in this pilot paper

Method
The study included 58 ESKD patients [55% men, mean age of 60.3 ± 11.7 years, and median hemodialysis therapy duration of 6.2 years (1.2 -25.7)], treated with HD (3 sessions of 4 hours /week with high flux dialyzers). Personal and laboratory data have been retrieved from the patients HD files. Cardiac ultrasound assessment was performed during the second HD session of the week, after 2 hours of HD therapy. Blood samples have been taken before the same HD session in order to determine FGF 23, BMP 2, IL 1 beta, Galectin 3 and soluble ST 2 levels. All patients signed an informed consent for the study participation and the use of personal and laboratory data for scientific purposes. The study was approved by the medical ethics committee of the “Victor Babes” University of medicine and pharmacy and of the ethics committee of the HD center.

Results
On cardiac ultrasound assessment the patients presented aorta atheroma in 74.1%, aorta valve fibrosis in 74.1%, mitral valve fibrosis in 74.1% of the cases. Calcifications have been evidenced at aorta valve level in 58.6%, mitral valve level in 75.8% and endomyocardial level in 67.2% of the cases. Increased left ventricular mass was present in 82.7%, enlarged interventricular septum in 74.1% of the cases. Decreased left ventricle diastolic filing (Appleton pattern - E/A) was evidenced in 55,1% of the cases and decreased left ventricular ejection fraction in 37.9%. Right ventricle enlargement was detected in 24.1% of the patients. At baseline, FGF 23 was inversely corelated with HD therapy duration (p = 0.01), ESA dose (p = 0.016), and directly with galectin 3 levels (p &lt; 0.05) but not with the ultrasound findings. BMP 2 levels corelated directly with serum albumin levels and inversely with left ventricle diastolic filing (E/A) (p &lt; 0.05). IL1 levels were inversely corelated with iPTH (p = 0.046), calcium (p = 0.046 and phosphate (p = 0.030) levels but not ultrasound findings, Galectin 3 inversely corelated with cu Hb (p = 0.002), Urea (p = 0.036) and K levels (p = 0.001) and directly with bicarbonate (p = 0.035), FGF 23 (p &lt; 0.05) and CRP levels (p&lt;0.0001), ST2 inversely corelated with ESA dose (p = 0.009) and decreased left ventricle diastolic filing (E/A) (p &lt; 0.05). At one year follow-up 12% of the patients died and mortality was significantly influenced by inter ventricle sept and right ventricle enlargement.

Conclusion
At baseline, though the investigated ESKD patients on HD therapy presented extensive cardiac valve fibrosis and heart valve and endomyocardial calcifications the investigated biomarker changes were not significantly supporting the ultrasound findings. One- and two-years follow-up results may reveal the utility of biomarker assessment for cardiovascular outcomes in HD treated ESKD patients.