Intradialytic changes in reflective properties of the arterial system during a single hemodialysis session
- 1 October 2005
- journal article
- Published by Wiley in Hemodialysis International
- Vol. 9 (4), 376-382
- https://doi.org/10.1111/j.1492-7535.2005.01156.x
Abstract
Increased aortic stiffness-measured as aortic augmentation index (AIx), a global stiffness marker-has emerged as a powerful predictor of survival in hemodialysis (HD). A single HD session is known to produce considerable improvement in aortic stiffness. We set out, for the first time, to examine the relative contributions to the post-HD drastic improvement in aortic stiffness of ultrafiltration rate and volume, or blood pressure (BP) changes. Aortic AIx (difference between the first and the second systolic peak of the aortic pressure waveform divided by pulse wave height) was determined hourly and recorded by applanation tonometry using a SphygmoCor device in 20 chronic HD patients (9 males, age 55.1 years). The other parameters recorded were: weight pre- and post-HD, ultrafiltration volume (UFV), hemoglobin, albumin, creatinine, urea reduction rate (URR), calcium and PTH, and BP. The dialysis significantly decreased AIx from 24.2+/-11.27% to 15.57+/-12.58% (p<0.05). In a univariate analysis, the intradialytic decrease in AIx (AIx 0-4) did not correlate with UFV, URR or with any of the biochemical markers. Significant correlations for AIx 0-4 were age (p=0.018), systolic blood pressure (SBP) at the beginning of HD (p=0.049), the intradialytic decrease in the SBP (p=0.001), and in pulse pressure (PP) (p=0.009). Multivariate stepwise regression showed that the decrease in SBP, PP, and intradialytic percentage reduction in weight explained 64.9% of the total variation in AIx 0-4. The decrease in SBP was the most important factor influencing the AIx variation (b=1.54, p=0.007). The most significant reduction in AIx was from the beginning of HD to the third hour (p=0.039), and correlated with the reduction in SBP (p=0.006) and PP (p=0.025) between the same moments. A single HD session produces a drastic improvement in aortic stiffness. The effect is not explained by the UFV depletion but is highly correlated with the decrease in SBP and PP. Further work is now needed to explore a potential role for endothelin and nitric oxide metabolism.Keywords
This publication has 21 references indexed in Scilit:
- Vascular calcification: A stiff challenge for the nephrologistKidney International, 2004
- Volume Status and Blood Pressure During Long-Term HemodialysisHypertension, 2003
- Effects of Endothelin-1 and Endothelin-1 Receptor Blockade on Cardiac Output, Aortic Pressure, and Pulse Wave Velocity in HumansHypertension, 2003
- Prospective Evaluation of a Method for Estimating Ascending Aortic Pressure From the Radial Artery Pressure WaveformHypertension, 2001
- Arterial Wave Reflections and Survival in End-Stage Renal FailureHypertension, 2001
- Peripheral “Oscillatory” Compliance Is Associated With Aortic Augmentation IndexHypertension, 2001
- Analysis of the effect of hemodialysis on peripheral and central arterial pressure waveformsKidney International, 2000
- Influence of Biochemical Alterations on Arterial Stiffness in Patients With End-stage Renal DiseaseArteriosclerosis, Thrombosis, and Vascular Biology, 1998
- Antihypertensive effects and arterial haemodynamic alterations during angiotensin converting enzyme inhibitionJournal of Hypertension, 1996
- Studies of the vessel wall properties in hemodialysis patientsKidney International, 1994