Impact of Serum Albumin and Dialysis Adequacy (spKt/V) on Pericardial Effusion Size in Patients on Hemodialysis

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Background: Pericardial effusion (fluid accumulation around the heart) is a known complication of advanced kidney disease and can pose significant risks in patients undergoing long-term dialysis. In patients receiving hemodialysis, serum albumin levels andspKt/V, a measure of dialysis adequacy are measured to assess the efficiency of hemodialysis. Low albumin levels, which often reflects malnutrition or inflammation, are linked to increased mortality. whereas, maintaining spKt/V at or above target levels is associated with better patient outcomes and improved survival. Methods: This is a retrospective study which included hemodialysis patients from our institution. Medical records were reviewed over a defined timeline, and 146 charts were screened. Inclusion criteria were: 1) Age ≥18 years, 2) End-stage kidney disease (ESKD) on dialysis, and 3) At least one available echocardiogram with pericardial effusion. A total of 22 patients who met inclusion criteria had serum albumin or spKt/v within 1 month of their echo dates. Echocardiograms (n=60) were manually reviewed, and pericardial effusions were measured in end systole and end diastole in six distinct locations in three different echocardiographic views. Spearman correlations were used to assess the correlation between lab parameters and total effusion size (measured in cm). Results: A total of 30 echocardiograms from 22 patients were analyzed. Patients were mostly male (73%), Caucasian (50%), and 91% were on maintenance hemodialysis. Hypertension was the most common comorbidity. The most common etiology of ESRD was diabetes related. spKt/V (R: 0.212, p = 0.269) showed weak positive, yet non-significant correlation with total effusion size, while albumin (R: -0.237, p = 0.208) showed a weak negative, non-significant correlation with total effusion size, indicating possible bidirectional relationships related to lab parameters. Conclusion: In this study of ESKD patients on hemodialysis, no significant correlations were found between total effusion size and lab parameters. Further studies are needed to explore the prognostic value of effusion characteristics and standardize assessment protocols with larger sample sizes.

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