True Arterial Stiffness Does Not Change between Dialysis Sessions during 1 Week in Outpatients on Intermitted Hemodialysis

Abstract

Introduction: End-stage renal disease (ESRD) is associated with exponentially elevated cardiovascular mortality. Arterial stiffness (AS) – usually expressed with pulse wave velocity (PWV) – is an established independent predictor of cardiovascular risk beyond the traditional risk factors. Higher PWV values are frequently observed in patients with ESRD. Due to the intrinsic physiologic relationship between PWV and prevailing arterial pressure, PWV can change without relevant changes in the arterial wall structure, and thus an individual pressure-independent expression of PWV is essential. Methods: The study is a single-center observational study. Repeated measurements of blood pressure (BP) and pulse wave analysis were performed during each dialysis session of 1 week. Aortic PWV was then adjusted to 120 mm Hg central systolic BP (PWV120) based on individually determined relationship. PWV120 values were compared between single sessions. Calculation of the PWV120 was performed retrospectively. Results: Fifty-four subjects were included, 61.1% of whom were male. The median age was 75.5 years, and median dialysis vintage was 33.1 months. Mean systolic/diastolic BP was 121.4/70.5 mm Hg, and the median heart rate was 64.6 beats/min. Mean PWV was 10.9 m/s, and mean PWV120 was 11.3 m/s. PWV120 did not change across single dialysis session during 1 week, while systolic, diastolic BP, PWV, and ultrafiltration volume differed significantly. Discussion/Conclusions: Our data suggest that true AS does not change in the short-term course in dialysis patients. The observed changes in PWV are rather associated with BP change due to intrinsic pressure dependence. Our analytical approach represents a novel method for this purpose, which is easy in performance and also applicable for large interventional trials and clinical practice.

The association between peri‐dialytic pulse wave velocity measurements and hemodialysis patient mortality

“…We measured PWV prior to HD sessions and there has been debate as to whether HD affects PWV, with some studies observing no effects and others a change in PWV, so questioning whether there is an optimal time make PWV measurements in HD patients 35‐37 . However, more recent studies have shown that after appropriate adjustment for changes in heart rate and blood pressure, 23 then dialysis sessions do not have a significant effect on PWV in the short‐term 38,39 . We chose to use an oscillograph method to determine PWV, as this measures aortic PWV, rather than by applanation tonometry which measures a composite of aortic and one or more conduit arteries.…”

“…[35][36][37] However, more recent studies have shown that after appropriate adjustment for changes in heart rate and blood pressure, 23 then dialysis sessions do not have a significant effect on PWV in the short-term. 38,39 We chose to use an oscillograph method to determine PWV, as this measures aortic PWV, rather than by applanation tonometry which measures a composite of aortic and one or more conduit arteries. As arterial disease and vascular stiffness varies within the arterial tree, we elected to measure aortic PWV, in keeping with the more recent multicenter European trials.…”

Does Pulse Wave Velocity Increase Over Time in Hemodialysis Patients?

“…While some earlier reports suggested changes in PWV during HD sessions [16, 17], later studies observed no significant change in PWV during either HD or hemodiafiltration treatments; however, there were changes in augmentation indices as expected associated with the ultrafiltration volumes [18-20]. Although there are many reports of single measurements of PWV in dialysis patients, there are very few studies of 2 or more measurements and no reports of long-term changes.…”

The Value of Serial Measurement of Arterial Stiffness in Cardiovascular Disease

“…Table 1 (Ref. [ 20 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ]) summarizes the results of several major studies related to serial measurement of arterial stiffness.…”