Predictors of cardiovascular events in patients with end-stage renal disease
Aim. Identification of cardiovascular risk factors and assessment its prognostic significance by comprehensive study of the cardiovascular system in patients with end-stage renal disease (ESRD) who are on different types of renal replacement therapy (RRT). Material and methods. Hemodialysis patients (HD group, n=83) and kidney recipients (KT group, n=27) underwent echocardiography for definition of the left ventricle (LV) remodeling and heart valves calcification degree, heart rate variability (HRV) (supine position and orthostatic), pulse wave velocity (PWV) by photoplethysmography. Logistic regression analysis was used to create predictive models. Results and discussion. Both groups' patients had similar characteristics: a significant reduction HRV, increased PWV, high (98%) prevalence of LV hypertrophy. Noted significant differences in the LV geometry: concentric hypertrophy was in 42% of the HD group and in 76% of the KT group, eccentric hypertrophy 55% and 20% of patients respectively (p=0,010). Calcification of heart valves is more common in the HD group (р=0,009). HD procedure increases sensitivity to cardiac autonomic effects but also increases arterial stiffness. Low HRV in orthostasis, low cholesterol and increase PWV are predictors of fatal cardiovascular events (CVE) in hemodialysis patients. HD, as a form of RRT, compared with the TP is a risk factor for CVE in ESRD patients. Conclusion. The study shows a high diagnostic and prognostic value of the data obtained by applying the proposed methods.