Chronic heart failure phenotypes in prevalent patients treated with hemodialysis: A single-center experience

Introduction/Objective. Heart failure (HF) is the main cause of morbidity and mortality of hemodialysis (HD) patients. The aim of this cross-sectional single-center study was to examine the following: 1. frequency and characteristics of HF phenotypes in prevalent HD patients, 2. association of HF with traditional and non-traditional risk factors for cardiovascular diseases. Methods. We included all 96 maintenance HD patients from Special Hospital for Internal Diseases, Lazarevac, Serbia, and determined the prevalence of HF with preserved ejection fraction (HFpEF) (per the 2016 criteria of the European Society of Cardiology) and HF with reduced and moderately reduced EF ? HFrEF + HFmrEF ? together in a group HFrEF (EF < 50%) using standardized post-HD transthoracic echocardiography. Clinical, routine laboratory and volume status parameters (by bioimpedance spectroscopy) was assessed. Results. Sixty-three out of 96 examined patients (65.6%) had HF, among them 42 had HFpEF (66.7%), and 21 had HFrEF (33.3%). HFrEF was more common in older males, with diabetic nephropathy as underlying kidney disease, with a longer dialysis vintage and in those with a previous history of ischemic heart disease. HFpEF was more common in males, with lower HD quality (kT/V) and higher pre-dialytic systolic blood pressure. In multivariable regression analysis, HFrEF was associated with diabetic nephropathy, hypervolemia (positively) and triglycerides (negatively), while HFpEF was associated negatively with hemoglobin, iron, and triglycerides. Conclusion. In order to control patients on maintenance HD with HF, in addition to appropriate drug therapy, it is advice to control of volemia and maintaining triglyceride, hemoglobin, and iron concentration approximately within normal limits.