PP.11.04

Objective: It is well known that both pressure and volume overloads contribute to left ventricular hypertrophy (LVH) and left ventricular dilatation in patients with chronic kidney disease (CKD). The aim of this study was to evaluate the impact of pulse pressure as an indirect assessment of arterial stiffness on ventricular geometry and left ventricular filling pressure in patients with end stage renal disease on peritoneal and hemodialysis treatment. Design and method: A case control study was conducted, enrolling all patients on chronic dialysis (HD and PD) who had more than 3 months in therapy. Two-dimensional echocardiography was performed 2–24 h after the dialysis session according to AEE recommendation. The ratio of early transmitral flow velocity (E) to early diastolic mitral annular velocity (Em) (E/Em ratio) assessed using tissue Doppler imaging was used for estimating LV filling pressure. Results: Our dialysis population studied consisted in 122 pts, 78 pts (61%) on hemodialysis, mean age 53.4 ± 14.5 years and mean time on therapy was of 40.4 ± 14.4 months. We didn’t found difference in PP between 2 groups (PD vs HD). Concentric hypertrophy was found in 42.3% of the pts in HD and 61.4% of pts in PD (p = 0.058) and eccentric hypertrophy in 43% of HD pts and in 29.5% of PD pts (p > 0.07). When the patients with LVH were stratified into tertiles based on their LVM-i there were found significantly increasing pulse pressure, across the three groups with increasing LVM-i (p = 0.036). Pulse pressure was found the only independent risk factor associated with LVM-i [1.04 (0.99–1.09) p < 0.05. Six % of patients on PD vs 16.8% on HD had E/Em Ratio>14 (p = 0.101). Patients with E/Em Ratio>14 have significantly higher PP value p = 0.039. Conclusions: These results suggest that severity of arterial stiffness have impact not only to cardiac remodelling but also to higher left ventricular filling pressure. The recognition of pulse pressure underline once again that more in focus needs to be the risk of vascular calcifications in ESRD patients.