Analysis of toxins removal, inflammation marker and cardiovascular outcome in patients with End Stage Renal Disease

Introduction Patients with End-Stage Renal Disease (ESRD) have a significantly higher risk of cardiovascular (CV) disease due to traditional risk factors (age, male gender, hypertension, diabetes, dyslipidemia, and physical inactivity) and uremic toxins, which independently contribute to CV damage. Chronic inflammation further exacerbates this risk. Methods This study evaluates the impact of hemodialysis (HD) on toxin removal, inflammatory status, and cardiac outcomes in ESRD patients starting chronic HD at the Nephrology Unit of IRCCS-AOU Bologna. Baseline clinical, biochemical, and echocardiographic data were collected at enrollment (T0) and after three years (T1). Cardiac outcomes included CV-related mortality and major adverse cardiovascular events (MACE: myocardial infarction, heart failure (HF) hospitalization, arrhythmias, and atrial fibrillation). Moreover correlation between uremic toxins retention and cardiac modification was made. Results Fifty-five patients (mean age 65.5 years, BMI 25.8) were enrolled. The overall MACE incidence was 47%. At follow-up, four patients (7.27%) died due to CV events, seven (12.7%) were hospitalized for HF, and 12 (23.5%) developed atrial fibrillation. Regarding cardiac remodeling the prevalence of pulmonary hypertension (p=0.041) and pericardial effusion (p=0.037) decreased. Significant correlations emerged between β2-microglobulin and ejection fraction (EF) (r=-0.462, p=0.035), as well as between Kt/V and EF (p=0.001) and ferritin level and interventricular septum thickness (r=0.383, p=0.031). Higher UF rate correlated with EF reduction (r =- 0.205, p=0.049). Multivariate logistic regression analysis showed a significant association between high UF rate and mortality. Conclusions Cardiovascular risk remains high in HD patients, potentially due to uremic toxin retention and dialysis-related factors. This study highlights the association between UF rate, toxins clearance, and cardiac function in ESRD patients undergoing chronic HD.