Vascular stiffness in incident peritoneal dialysis patients over time

Tang, Mila; Romann, Alexandra; Chiarelli, Giusy; Djurdjev, Ognjenka; Beaulieu, Monica; Sigrist, Mhairi K.; Taylor, Paul; Singh, Suneet; Levin, Adeera

doi:10.5414/cn107398

Cited by 8 publications

(8 citation statements)

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“…Notably, we did not see any correlation between changes in baPWV and HbA1c or body-fluid overload (ΔECW/ TBW) during PD, consistent with the observations by others. [18][19][20][21] Moreover, there was no relationship between changes in baPWV and serum calcium and phosphorus levels. These results together suggested that BP control is the first-line approach to retard or even reverse vascular stiffness in the first few years after introducing PD.…”

Section: Discussionmentioning

confidence: 87%

“…11,13) Most previous studies employed the femoral and heart (hfPWV) 18) or carotid (cfPWV), a well-established index of central arterial stiffness. [19][20][21] The cfPWV measures stiffness from the aorta to iliofemoral axes, while baPWV reflects one in not only central elastic arteries but also peripheral muscular arteries. Our 2-year follow-up observations indicated that BP is a prime determinant of baPWV: nearly half of our patients had a decreasing baPWV during the first PD year.…”

Section: Discussionmentioning

confidence: 99%

“…The stiffnesslowering effects have been missed in previous longitudinal studies, [18][19][20][21] because the PWV was measured at two arbitrary time points in the maintenance phase when approximately 6 months passed after initiating PD. Then, we found that baPWV exhibited a trend of increasing over the second PD year in parallel with the gradual rise in BP.…”

Section: Discussionmentioning

confidence: 99%

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Determinants of the Change in Arterial Stiffness in Peritoneal Dialysis Patients

et al. 2017

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SummaryArterial stiffness is an important risk factor for cardiovascular disease (CVD) in patients with end-stage renal failure. However, little is known about the factors that contribute to arterial rigidity in peritoneal dialysis (PD) patients. The aim of this study was to define the pattern and determinants of the longitudinal change in arterial stiffness after PD initiation.Arterial stiffening was estimated for 46 PD patients by using brachial-ankle pulse wave velocity (baPWV) and carotid intima-media thickness (cIMT). The cross-sectional relationship between the arterial markers and their clinical determinants was studied. The longitudinal effects of blood pressure (BP), body fluid status, and glucose were studied over the two years after initiating PD.Multivariate analysis showed that higher baPWV was associated positively with urinary protein excretion (P < 0.001), systolic BP (P = 0.001), and hemoglobin A1c (P = 0.003). In contrast, increased cIMT correlated with smoking (P = 0.004) and hypoalbuminemia (P = 0.04), suggesting that endothelial dysfunction is implicated in the atherogenic process. Neither cIMT nor baPWV correlated significantly with other PD-related covariates of volume overload, peritoneal solute transport, kidney function, and C-reactive protein. Longitudinal observation demonstrated that BP had a greater influence on baPWV changes than hyperglycemia or fluid status.Our study indicates that 1) baPWV represent an arterial marker that integrates multifactorial interaction between modifiable variables including BP and plasma glucose; and 2) intervention aimed at controlling BP as well as nutritional conditions (glucose and albumin) may reduce CVD risk in PD patients. (Int Heart J 2017; 58: 915-925)

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Determinants of the Change in Arterial Stiffness in Peritoneal Dialysis Patients

et al. 2017

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“…This increase was also observed in carotid-radial PWV. In contrast, Tang and coworkers showed that a PWV improvement found in peritoneal dialysis patients is associated with modifiable risk factors [ 18 ]. The authors found that 23% of patients undergo a decrease of carotid-femoral PWV values after a six-month follow-up, compared to the baseline data ( Table 2 ).…”

Section: Peritoneal Dialysis and Arterial Stiffnessmentioning

confidence: 99%

Arterial Stiffness and Renal Replacement Therapy: A Controversial Topic

Fischer

Zócalo²,

Galli

et al. 2015

International Journal of Nephrology

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The increase of arterial stiffness has been to have a significant impact on predicting mortality in end-stage renal disease patients. Pulse wave velocity (PWV) is a noninvasive, reliable parameter of regional arterial stiffness that integrates the vascular geometry and arterial wall intrinsic elasticity and is capable of predicting cardiovascular mortality in this patient population. Nevertheless, reports on PWV in dialyzed patients are contradictory and sometimes inconsistent: some reports claim the arterial wall stiffness increases (i.e., PWV increase), others claim that it is reduced, and some even state that it augments in the aorta while it simultaneously decreases in the brachial artery pathway. The purpose of this study was to analyze the literature in which longitudinal or transversal studies were performed in hemodialysis and/or peritoneal dialysis patients, in order to characterize arterial stiffness and the responsiveness to renal replacement therapy.

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“…Since the aorta is the principal capacitive element of the arterial tree, non-invasive measurements of stiffness in the aorta obtained by applanation tonometry using the carotid-femoral pulse wave velocity (cf-PWV) can more accurately reflect the physiologic effects of increased arterial stiffness on the heart [ 13 , 14 ]. Indeed, elevated cf-PWV in ESRD patients who are treated with peritoneal dialysis, hemodialysis, or renal transplantation is an excellent predictor of fatal cardiovascular events and all-cause mortality [ 15 – 19 ]. An increase of 1 m/s in cf-PWV in ESRD patients increases both cardiovascular and overall mortality by 34 % by crude estimates and by 14 % after adjusted analyses [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

The impact of intervention strategies that target arterial stiffness in end-stage renal disease: a systematic review protocol

et al. 2016

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Background/objectivesVascular damage contributes to the high cardiovascular morbidity and mortality in end-stage renal disease (ESRD). Increased aortic stiffness measured by carotid-femoral pulse wave velocity (cf-PWV) is a strong and independent predictor of the cardiovascular risk in ESRD patients. Recently, there has been considerable interest in developing strategies to lessen the progression of arterial stiffness in ESRD patients using cf-PWV as a tool to monitor therapeutic responses, but their benefit on the long-term cardiovascular risk is not known. Appraisal of the effects of existing stiffness-based interventions on the cf-PWV would facilitate selecting optimal therapies to be tested in randomized clinical trials. The aim of this systematic review will be to evaluate the impact of arterial stiffness-based interventions on the cf-PWV in ESRD patients. Secondarily, for each intervention, we will determine the minimal duration needed to achieve a significant reduction of cf-PWV, the minimal cf-PWV reduction threshold or effect size, and adverse events.Methods/designThis review will be conducted using MEDLINE, EMBASE, and EBM Reviews. We will select clinical trials and observational studies (cohort, case-control, and before/after studies and case series) that evaluated pharmacologic or non-pharmacologic interventions in which the primary effect is to improve structural and/or dynamic components of arterial stiffness in adults with stage 5 chronic kidney disease. The primary outcome of interest will be cf-PWV. Study selection and data collection will be performed by two reviewers. Validated tools will be used to assess the methodological quality and risk of bias among different study designs. We will describe all included citations according to study characteristics, methodological quality, and outcomes. Suitability for meta-analysis will be determined by the degree of clinical and statistical heterogeneity between studies. If appropriate, we will calculate effect estimates by obtaining the relative risks with 95 % confidence intervals pooled according to study design using a random effects model.DiscussionThis review will summarize evidence regarding effects of interventions targeting arterial stiffness in ESRD patients. Our results will inform clinicians and researchers on the type of existing arterial stiffness-based interventions for ESRD patients and their potential efficacy and safety, with a goal to guide future clinical trials aimed at reducing adverse cardiovascular events.Systematic review registrationPROSPERO CRD42016033463Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0286-5) contains supplementary material, which is available to authorized users.

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Vascular stiffness in incident peritoneal dialysis patients over time

Cited by 8 publications

References 0 publications

Determinants of the Change in Arterial Stiffness in Peritoneal Dialysis Patients

Determinants of the Change in Arterial Stiffness in Peritoneal Dialysis Patients

Arterial Stiffness and Renal Replacement Therapy: A Controversial Topic

The impact of intervention strategies that target arterial stiffness in end-stage renal disease: a systematic review protocol

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