Relationship between Fluctuation Pattern of Blood Pressure during Hemodialysis Treatment and Cardiovascular Morphology: An Autopsy Study of 53 Cases

Matsumae, Tomoji; Matsumae, Masako; Hasegawa, Yoshiyuki; Tanaka, T; Yoshitake, Kenzo; Noda, Ryuichi; Ogahara, Satoru; Murata, Toshiaki; Kaneoka, Hidetoshi

doi:10.1159/000045970

Cited by 5 publications

(6 citation statements)

References 23 publications

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“…Specific explanations for the pathogenetic link between the above risk factors and individual MIDA components are suggested as follows: (1) Arteriosclerosis-induced vascular stiffening will increase afterload and systolic blood pressure. The accompanying increase in pulse pressure and the relative decrease in aortic diastolic blood pressure could result in reduced diastolic coronary blood-flow, which will eventually diminish cardiac compensation for the loss of blood volume resulting in intradialytic hypotension [33]. (2) The low PTH level shown in the high MIDA score group characterizes low bone turnover state in which the bone is unable to buffer circulating calcium [34].…”

Section: Discussionmentioning

confidence: 99%

The Malnutrition-Inflammation-Depression-Arteriosclerosis Complex Is Associated with an Increased Risk of Cardiovascular Disease and All-Cause Death in Chronic Hemodialysis Patients

Choi¹,

Seo²,

Yoon³

et al. 2013

Nephron Clin Pract

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Background: In chronic hemodialysis patients, malnutrition, inflammation, depression and arteriosclerosis are pathogenetically associated suggesting the presence of malnutrition-inflammation-depression-arteriosclerosis (MIDA) complex acting as a risk factor for cardiovascular disease (CVD). Methods: Nutritional status was assessed by serum albumin, subjective global assessment and normalized protein catabolic rate (nPCR). Inflammation was assessed by serum high-sensitivity C-reactive protein (hsCRP). Depression was assessed with the Beck Depression Inventory and DSM-IV criteria. The severity of arteriosclerosis was measured by pulse wave velocity (PWV). Results: Among 81 hemodialysis patients, 44 (54.3%) had malnutrition (albumin <4.0 mg/dl with subjective global assessment score <6 and/or nPCR <1.0) and 39 (48.1%) had inflammation (hsCRP >1 mg/l). The prevalence of depression was 50.6% (n = 41). Fifty-nine (73.8%) had arteriosclerosis (measured PWV > expected PWV based on age/blood pressure/gender adjustment). The severity of the all four individual MIDA components correlated well with each other. The average number of the MIDA complication (MIDA score) was 2.27 ± 1.33. -During the 5-year follow-up, 40 cases of CVD and 26 cases of all-cause death occurred. In Cox analysis adjusted for -previous CVD, age, diabetes, blood pressure, pulse pressure, intradialytic hypotension, B-type natriuretic peptide, -hemoglobin and hemodialysis incompliance, the MIDA score was an independent predictor of CVD and all-cause death: hazard ratio (95% confidence interval); 1.89 (1.13-3.17) and 3.48 (1.32-9.21) for an increase of 1 MIDA score. Conclusions: This study suggests the presence of MIDA complex, which is composed of malnutrition, inflammation, depression and arteriosclerosis. The MIDA complex syndrome was an independent risk factor for CVD and all-cause death in chronic hemodialysis patients.

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Section: Discussionmentioning

confidence: 99%

The Malnutrition-Inflammation-Depression-Arteriosclerosis Complex Is Associated with an Increased Risk of Cardiovascular Disease and All-Cause Death in Chronic Hemodialysis Patients

Choi¹,

Seo²,

Yoon³

et al. 2013

Nephron Clin Pract

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“…A decrease in SBP during HD of >10 mmHg without causing significant hypotension was associated with lower hospitalization and mortality at 6 months 3 . In contrast, a significant decrease in SBP during HD (>40 mmHg) or symptomatic hypotension is associated with increased 2‐year mortality and worse left ventricular hypertrophy (LVH) or atherosclerosis 4,5 . Intradialytic hypotension may induce coronary ischemia and/or myocardial stunning 12 .…”

Section: Introductionmentioning

confidence: 89%

“…3 In contrast, a significant decrease in SBP during HD (440 mmHg) or symptomatic hypotension is associated with increased 2-year mortality and worse left ventricular hypertrophy (LVH) or atherosclerosis. 4,5 Intradialytic hypotension may induce coronary ischemia and/or myocardial stunning. 12 Higher BP variability has also been associated with sympathetic overactivity.…”

Section: Introductionmentioning

confidence: 99%

“…The large increase in risk compared with the general population cannot be completely accounted for by traditional (Framingham) cardiovascular risk factors. A number of investigators have begun to connect characteristics of the blood pressure (BP) fluctuation with increased morbidity and mortality in dialysis patients 1–5 as well as in the general population 6 . How BP fluctuations effect CV outcomes in dialysis patients remains a source of considerable controversy and is hampered by disagreement over which parameters matter most and how, exactly, measurements should be carried out.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of intradialytic blood pressure variability between conventional thrice‐weekly hemodialysis and short daily hemodialysis

Murashima

Kumar

Doyle

et al. 2010

Hemodialysis International

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Intradialytic blood pressure (BP) variability may be associated with increased mortality. We examined the effect of short daily hemodialysis (SDHD) on intradialytic BP variability relative to conventional thrice-weekly HD (CHD). This is a retrospective cohort study. Subjects were those converted from CHD to SDHD (n=12). All intradialytic BPs were collected on the last month of CHD, and on month 6 of SDHD. Absolute predialysis BP level and intradialytic BP variability were defined as the intercept and average residual terms, respectively, from a mixed-effects linear regression model of time on BP. Dialysis modality was a predictor variable (CHD vs. SDHD). Outcome variables were intradialytic BP variability and hypotension (BP<90/55 mmHg at any time during HD). In addition to a predictor and outcomes, the demographics, estimated dry weight, and ultrafiltration ratio were examined. The median (range) age of the patients was 48 (34-77); all had hypertension, and 4 (33%) had diabetes. By a mixed effects linear regression model, the intradialytic systolic BP variability was 13.2 (quartile range 9.5-14.0) mmHg and 10.0 (8.3-10.9) mmHg for CHD and SDHD, respectively (P<0.006). Intradialytic diastolic BP variability was also significantly reduced (7.7 [6.4-9.2] vs. 6.1 [5.5-6.6] mmHg, P=0.005). Relative to CHD, less hypotension was observed during treatment on SDHD: the odds ratio (95% confidence interval) was 0.36 (0.16-0.81; P=0.008). In this retrospective study, SDHD was associated with less intradialytic BP variability and with fewer episodes of hypotension during treatments. Further studies are necessary to generalize these findings.

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“…However, no clear threshold values as targets for antihypertensive therapy have been currently defined in HD patients and no guidelines are available for antihypertensive therapy in these patients since BP has not been found to predict outcome in some studies [4] . Recent literature regarding BP variability show an association with atherosclerotic complications [5] . Therapeutic compounds which inhibit the Renin-Angiotensin-System (RAS), e.g.…”

Section: Introductionmentioning

confidence: 99%

Dialysis-Associated Hypertension Treated with Telmisartan – DiaTel: A Pilot, Placebo-Controlled, Cross-Over, Randomized Trial

et al. 2013

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Treatment of hypertension in hemodialysis (HD) patients is characterised by lack of evidence for both the blood pressure (BP) target goal and the recommended drug class to use. Telmisartan, an Angiotensin receptor blocker (ARB) that is metabolised in the liver and not excreted via HD extracorporeal circuit might be particularly suitable for HD patients. We designed and conducted a randomised, placebo-controlled, double-blind and cross-over trial for treatment of dialysis–associated hypertension with telmisartan 80 mg once daily or placebo on top of standard antihypertensive treatment excluding other Renin-Angiotensin-System (RAS) blockers. In 29 patients after randomization we analysed BP after a treatment period of 8 weeks, while 13 started with telmisartan and 16 with placebo; after 8 weeks 11 continued with telmisartan and 12 with placebo after cross-over, respectively. Patients exhibited a significant reduction of systolic pre-HD BP from 141.9±21.8 before to 131.3±17.3 mmHg after the first treatment period with telmisartan or placebo. However, no average significant influence of telmisartan was observed compared to placebo. The latter may be due to a large inter-individual variability of BP responses reaching from a 40 mmHg decrease under placebo to 40 mmHg increase under telmisartan. Antihypertensive co-medication was changed for clinical reasons in 7 out of 21 patients with no significant difference between telmisartan and placebo groups. Our starting hypothesis, that telmisartan on top of standard therapy lowers systolic office BP in HD patients could not be confirmed. In conclusion, this small trial indicates that testing antihypertensive drug efficacy in HD patients is challenging due to complicated standardization of concomitant medication and other confounding factors, e.g. volume status, salt load and neurohormonal activation, that influence BP control in HD patients.Trial Registration Clinicaltrialsregister.eu 2005-005021-60

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Relationship between Fluctuation Pattern of Blood Pressure during Hemodialysis Treatment and Cardiovascular Morphology: An Autopsy Study of 53 Cases

Cited by 5 publications

References 23 publications

The Malnutrition-Inflammation-Depression-Arteriosclerosis Complex Is Associated with an Increased Risk of Cardiovascular Disease and All-Cause Death in Chronic Hemodialysis Patients

The Malnutrition-Inflammation-Depression-Arteriosclerosis Complex Is Associated with an Increased Risk of Cardiovascular Disease and All-Cause Death in Chronic Hemodialysis Patients

Comparison of intradialytic blood pressure variability between conventional thrice‐weekly hemodialysis and short daily hemodialysis

Dialysis-Associated Hypertension Treated with Telmisartan – DiaTel: A Pilot, Placebo-Controlled, Cross-Over, Randomized Trial

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