Parameters associated with epicardial fat tissue thickness in hemodialysis patients

Introduction and Objective Strategies to reduce cardiovascular risk in CKD still need further evaluation, particularly in large studies involving patients with advanced or end-stage renal disease. The increasing number of end-stage renal disease patients requiring hemodialysis has led to a disproportionately high risk of cardiovascular disease (CVD) and mortality and has become a major clinical concern. Epicardial adipose tissue (EAT) is thought to be one of the important causes of cardiovascular disease (CVD) development in the population receiving hemodialysis treatment. In this study we aimed to investigate parameters that are well-known to be related to epicardial adipose tissue thickness in patients with end-stage renal disease receiving hemodialysis treatment as well as other parameters related to the hemodialysis procedure. We aimed to contribute to the literature and to help prevent cardiovascular diseases, which are the biggest risk factors for mortality in hemodialysis patients, by defining the correctable parameters that cause epicardial adipose tissue development and treating or controlling cardiovascular disease before it develops. Materials and Methods This descriptive study included 93 male and female volunteers, over the age of 18, who received hemodialysis treatment in Erzincan Binali Yıldırım University Faculty of Medicine Mengücek Gazi Training and Research Hospital Hemodialysis Unit and in a private dialysis center in Erzincan. Patients under the age of 18, those who received hemodialysis treatment for less than 6 months and patients who did not volunteer to participate were excluded from the study. The biochemical parameters examined in our patients were the parameters checked in the periods specified by T.R. The Ministry of Health's Regulation on Dialysis Centers dated March 1, 2019 and in Annex 3 of the same regulation, and the results of laboratory tests between 01/07/2022 and 13/01/2023 were obtained from the patient files and evaluated. In our study, the averages of the last 6-month examination results of the biochemical parameters of our patients were used. EAT measurement procedures were performed by the same cardiologist experienced in the field. EAT thickness measurements were made with two-dimensional echocardiography method at the end of systole from the parasternal long axis images and the area between the right ventricular free wall and the pericardium, where the line drawn as perpendicular as possible to the aortic annulus, determined as the anatomical landmark, passes. The measurement value is expressed in millimeters (mm). Results A total of 93 patients, 38.7% female (n=36) and 61.3% male (n=57), were included in the study. The mean age of the patients was 61.41±12, and the median age was 63 (minimum 22-maximum 88). The mean body mass index of all participants was 25.5±4.89 kg/m2 and the mean waist circumference was 97.8±12.7 cm. The mean EAT thickness of the patients included in our study was 4.94±1.38, and the median EAT value was 4.7 (minimum 2.5- maximum 8.5) mm. A statistically significant correlation was found between EAT and BMI, waist circumference, albumin, uric acid, smoking, male gender, and a history of CAD. A statistically significant correlation was found between CRP and albumin and hemoglobin levels. Conclusion In our study, parameters related to EAT thickness in HD patients were evaluated. A close relationship was found between EAT and BMI, waist circumference, albumin, uric acid, hemoglobin categories, male gender, CAD, and smoking. Higher EAT thickness in HD patients with hemoglobin levels below 10 g/dL have suggested that these patients might have a higher CVD risk because of increased EAT due to the direct and/or indirect effect of anemia, apart from the known cardiovascular risks associated with anemia. Therefore, we think that the early initiation of the treatment of patients with hemoglobin level below 10 g/dL among the patients receiving HD treatment, and the close follow-up of this patient group, and the increase of hemoglobin levels with appropriate treatment protocols will reduce the risk of CVD. The data we obtained from our study suggest that low albumin in HD patients is associated with inflammation rather than nutrition. This picture proves that the increase in EAT, which is shown to be negatively correlated with albumin, is also primarily associated with inflammation. In our study, low albumin levels developed secondary to inflammation in our patients suggests that albumin levels may be a safer predictor of EAT thickness and increased cardiovascular risks in areas where high-sensitivity CRP cannot be measured, and that it is a parameter that should be closely monitored in HD patients. It was considered that EAT is one of the important causes that paves the way for the development of CVD in the population receiving HD treatment. We think that identifying the correctable parameters that cause the development of EAT and treating or controlling CVD before it develops may help prevent cardiovascular diseases, which are the biggest risk factors for mortality in hemodialysis patients. Our study is a descriptive study conducted with a limited number of participants treated locally in a public and a private hemodialysis center. We think that the biochemical, demographic and other parameters related to EAT in HD patients need to be evaluated in further studies with larger numbers of patients. Keywords: Hemodialysis (HD), Epicardial Adipose Tissue (EAT), Cardiovascular Disease (CVD)