Determinants of Arterial Wall Stiffness and Peripheral Artery Occlusive Disease in Nondiabetic Hemodialysis Patients

Matsumae, Tomoji; Abe, Yasuhiro; Murakami, Genji; Ishihara, Motoichi; Saito, Takao

doi:10.1291/hypres.30.377

Cited by 32 publications

(33 citation statements)

References 39 publications

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“…In ESRD patients, chronic inflammation, as expressed by increased CRP levels, has been identified as accelerating atherosclerosis (39). Data from several studies have demonstrated that elevated levels of the acute-phase reactant CRP were associated with increased cardiovascular events and atherosclerosis (decreased ABI) (40,41). In the present study, there was no correlation between high-sensitivity CRP and ABI Ͻ0.9 or vascular access failure.…”

Section: Discussioncontrasting

confidence: 48%

Significant Correlation between Ankle-Brachial Index and Vascular Access Failure in Hemodialysis Patients

Chen¹,

Chang²,

Hwang³

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: Vascular access failure (VAF) is associated with increased morbidity and mortality in hemodialysis patients. The most common cause of VAF is stenosis at the arteriovenous anastomosis because of abnormal neointimal proliferation and extracellular matrix deposition. These two changes are also observed in the classic atheroma, which means atherosclerotic lesions and venous stenosis in VAF may share some similar pathogenic mechanisms. The ankle-brachial index (ABI) is a reliable marker for atherosclerosis. The aim of this study was to evaluate the relationship between ABI <0.9 and VAF.Design, setting, participants, & measurements: All routine hemodialysis patients in one regional hospital were included except for six patients refusing ABI examinations and four patients with atrial fibrillation. Finally, 225 patients formed our study group. The study subjects were observed from arteriovenous access creation until the first episode of VAF. The mean observation period was 42.2 ؎ 42.8 mo. The relative VAF risk was analyzed by Cox-regression methods with adjustments for demographic and comorbid conditions. Results: VAF episodes were recorded in 111 patients. In multivariate analysis, ABI <0.9 (hazard ratio, 1.893; P ‫؍‬ 0.039), vascular access type of arteriovenous graft (P ‫؍‬ 0.004), and serum triglyceride level (P ‫؍‬ 0.043) were positively associated with VAF, and serum parathyroid hormone level (P ‫؍‬ 0.043) was negatively associated with VAF.Conclusions: Our findings show that ABI <0.9 is significantly correlated with increased VAF. Screening hemodialysis patients by means of ABI may help to identify a high-risk group for VAF.

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Section: Discussioncontrasting

confidence: 48%

Significant Correlation between Ankle-Brachial Index and Vascular Access Failure in Hemodialysis Patients

Chen¹,

Chang²,

Hwang³

et al. 2009

Clinical Journal of the American Society of Nephrology

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“…In a similar fashion, serum albumin may have correlated with cfPWV in nondiabetic patients but not in diabetic patients. To our knowledge, only a few studies have evaluated the influence of serum albumin on aortic stiffness in patients with or without ESRD (10,28). Further evaluation is necessary to understand this correlation.…”

Section: Discussionmentioning

confidence: 99%

“…We recently demonstrated in a cross-sectional study that HbA1c level, HD duration, heart rate (HR), and mean blood pressure are independent determinants of aortic stiffness in HD patients without diabetes (10). However, it remains unclear whether the determinants of aortic stiffness in ESRD patients vary according to the presence or absence of diabetes, and whether or not aortic stiffness relates to vascular complica-tions in ESRD patients.…”

Section: Introductionmentioning

confidence: 99%

Effects of Glucose Metabolism on Aortic Pulse Wave Velocity in Hemodialysis Patients with and without Diabetes

Matsumae¹,

Abe

Murakami³

et al. 2008

Hypertens Res

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“…Recently, we described that hemoglobin A1c was an independent contributor to aortic PWV not only in diabetic HD patients, but also in non-diabetic HD patients. 8,9 However, there have been only a few studies that elucidated the factors that contribute to the rate of progression of arterial stiffening in ESRD patients treated with HD.…”

Section: Introductionmentioning

confidence: 99%

What factors accelerate aortic stiffening in hemodialysis patients? An observational study

Matsumae¹,

Abe

Nishimura³

et al. 2010

Hypertens Res

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Increased aortic stiffness is an independent predictor of death from cardiovascular disease in patients with end-stage renal disease (ESRD). Various factors that contribute to carotid-femoral pulse wave velocity (cfPWV) as a surrogate of aortic stiffness have been identified, but determinants of long-term worsening of aortic stiffness remain to be elucidated. To clarify the factors that accelerate aortic stiffness in hemodialysis patients, 148 patients with ESRD on hemodialysis were evaluated. At baseline, cfPWV and ankle-brachial blood pressure index (ABPI) were measured and clinical status including biochemical parameters, with or without hepatitis c virus (HCV) infection, diabetes mellitus (DM), cardiovascular disease, cerebrovascular disease and peripheral arterial disease at baseline, were evaluated. The cfPWV was measured again after a 3-year follow up and the annual change in cfPWV was calculated. The cfPWV decreased in 54 patients, worsened slowly in 47 (annual change in cfPWV ranged from 0 to 0.33 m s À1 per year), and worsened rapidly in 47 patients (annual change in cfPWV was more than 0.33 m s À1 per year). The prevalences of DM, HCV infection and peripheral arterial disease were the highest in the rapid progression group. Univariate analysis showed that age, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), LDL-C/HDL-C ratio, HCV infection, ABPI and number of vasculopathies were significantly associated with annual change in cfPWV. Stepwise regression analysis identified ABPI, LDL-C/HDL-C ratio and HCV infection as independent determinants of worsening of cfPWV. Further studies are needed to investigate the mechanism of HCV-related enhancement of aortic stiffness in ESRD patients.

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Determinants of Arterial Wall Stiffness and Peripheral Artery Occlusive Disease in Nondiabetic Hemodialysis Patients

Cited by 32 publications

References 39 publications

Significant Correlation between Ankle-Brachial Index and Vascular Access Failure in Hemodialysis Patients

Significant Correlation between Ankle-Brachial Index and Vascular Access Failure in Hemodialysis Patients

Effects of Glucose Metabolism on Aortic Pulse Wave Velocity in Hemodialysis Patients with and without Diabetes

What factors accelerate aortic stiffening in hemodialysis patients? An observational study

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