Arterial stiffness in dialysis patients: where are we now?

Abstract

Patients with end-stage renal disease treated by chronic dialysis have an impressive mortality, which more than half of this mortality is attributable to cardiovascular disease. Despite stratification for sex, race, and the presence of diabetes, cardiovascular disease mortality is 10-30 times higher in dialysis patients compared to general population. In dialysis patients, both atherosclerosis (mainly affecting the intima of the arteries) and arteriosclerosis (affecting predominantly the media of large- and middle-sized arteries diffusely) are highly prominent. Arteriosclerosis characterized by reduced arterial compliance (i.e., reduced elasticity of the arteries) is due to increased fibrosis, loss of elastic fibers, and extensive vessel wall calcification. Arteriosclerosis is closely related to arterial stiffness. A generally accepted mechanistic view is that an increase in arterial stiffness causes a premature return of reflected waves in late systole, increasing central pulse pressure, thus systolic. An increased arterial stiffness can increase the risk of stroke through several mechanisms, including an increase in central pulse pressure, influencing arterial remodeling both at the site of the extracranial and intracranial arteries, increasing carotid wall thickness, and the development of stenosis and plaques, and the likelihood of plaque rupture. Very importantly, it was also suggested that arterial stiffness itself independently plays a role in exacerbating chronic kidney disease progression. This review deals briefly with the definition of arterial stiffness, methods of measuring arterial stiffness and pathophysiology of arterial stiffness, and factors related with arterial stiffness.

Association of Parathyroid Hormone and 25-OH-Vitamin D Levels with Arterial Stiffness in Postmenopausal Women with Vitamin D Insufficiency

“…tic stiffness. Moreover, it should be kept in mind that several factors, other than PTH, are established determinants of arterial stiffening in patients with endstage renal disease 43) and include malnutrition, chronic volume overload, dialysated calcium and others [44][45][46] . Importantly, in the present study, inclusion of patients with a normal glomerular filtration rate allowed us to exclude most of these confounders.…”

Effects of the Ankle-brachial Blood Pressure Index and Skin Perfusion Pressure on Mortality in Hemodialysis Patients

“…In dialysis patients, both atherosclerosis (primarily affecting the intima of the arteries) and arteriosclerosis (predominantly affecting the media of large-and middle-sized arteries diffusely) are highly prominent. Arteriosclerosis, which is characterized by reduced arterial compliance (i.e., reduced elasticity of the arteries), is caused by increased fibrosis, loss of elastic fibers and extensive vessel wall calcification (15)]. The transformation of vascular smooth muscle cells into chondrocytes or osteoblast-like cells appears to be a key element in the pathogenesis of vascular calcification, in the context of passive calcium and phosphate deposition resulting from abnormal bone metabolism and impaired renal excretion (16).…”

Benefits of Exercise Training during Hemodialysis Sessions: A Prospective Cohort Study

“…Atherosclerosis (affecting the intima of the arteries) and arteriosclerosis (affecting the media of the large and middle-sized arteries), the most frequent causes of arterial stiffness, are highly prevalent in hemodialyzed (HD) patients [3]. The link between stiff arteries and the increased number of cardiovascular events is well described.…”