Acute effects of haemodialysis on endothelial function and large artery elasticity

Kosch, Markus; Levers, Andrea; Barenbrock, Michael; Matzkies, F; Schaefer, Roland M.; Kisters, Klaus; Rahn, K. H.; Hausberg, Martin

doi:10.1093/ndt/16.8.1663

Cited by 61 publications

(69 citation statements)

References 22 publications

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“…7,20 When carotid-femoral PWV was used as a marker of aortic stiffness, no direct effect of fluid withdrawal was found in previous studies. 7,21 This is in agreement with our study in which there was no significant change in carotid-femoral PWV after HD with UF. The variability of our results for PWV may be partly responsible for this, although there was a trend toward a decrease after HD.…”

Section: Discussionsupporting

confidence: 92%

“…27 It would therefore appear that, when volume reduction by UF does not lead to a decrease in pressure, other factors leading to functional changes of the arterial wall offset the beneficial effect of volume withdrawal. 21 Although volume withdrawal in our study had an acute, albeit small, impact on arterial wall characteristics, high PWV values and marked augmentation continued to be present after HD. This indicates that the acute large swing in volume status before and after HD affects arterial stiffness on top of a more permanent alteration in arterial structure and function, which is likely to be caused by chronic volume overload.…”

Section: Discussionmentioning

confidence: 47%

“…In one study, pulse pressure increased rather than decreased, although not significantly, and carotid distensibility decreased after HD. 21 This was despite a mean UF volume of 1460 ml. The authors suggested this might be due to sympathetic activation, as there was no change in distensibility when corrected for pressure.…”

Section: Discussionmentioning

confidence: 97%

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Ultrafiltration improves aortic compliance in haemodialysis patients

Backer

Carlier

et al. 2005

J Hum Hypertens

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An elevated pulse pressure leads to an increased pulsatile cardiac load, and results from arterial stiffening. The aim of our study was to test whether a reduction in volume overload by ultrafiltration (UF) during haemodialysis (HD) leads to an improvement of aortic compliance. In 18 patients, aortic compliance was estimated noninvasively before and after HD with UF using a pulse pressure method based on the Windkessel model. This technique has not been applied before in a dialysis population, and combines carotid pulse contour analysis by applanation tonometry with aortic outflow measurements by Doppler echocardiography. The median UF volume was 2450 ml (range 1000-4000 ml). The aortic outflow volume after HD (39 ml; 32-53 ml) was lower (P ¼ 0.01) than before (46 ml; 29-60 ml). Carotid pulse pressure after HD (42 mmHg; 25-85 mmHg) was lower (P ¼ 0.01) than before (46 mmHg; 35-93 mmHg).Carotid augmentation index after HD (22%; 3-30%) was lower (P ¼ 0.001) than before (31%; 7-53%). Carotidfemoral pulse wave velocity was not different after HD (8.7 m/s; 5.6-28.9 m/s vs 7.7 m/s; 4.7-36.8 m/s). Aortic compliance after HD (1.10 ml/mmHg; 0.60-2.43 ml/ mmHg) was higher (P ¼ 0.02) than before (1.05 ml/mmHg; 0.45-1.69 ml/mmHg). The increase in aortic stiffness in HD patients is partly caused by a reversible reduction of aortic compliance due to volume expansion. Volume withdrawal by HD moves the arterial wall characteristics back to a more favourable position on the nonlinear pressure-volume curve, reflected in a concomitant decrease in arterial pressure and improved aortic compliance.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 47%

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Ultrafiltration improves aortic compliance in haemodialysis patients

Backer

Carlier

et al. 2005

J Hum Hypertens

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“…Therefore, it would appear intriguing that acute volume reduction by ultrafiltration does not always acutely improve arterial stiffness. [3][4][5][6][7] Dialysis with a 'low-calcium' dialysate (1.50 mmol/l) did not change aPWV, while dialysis with a 'high-calcium' dialysate (1.75 mmol/l) even induced a significant increase in aPWV. 6 Haemodialysis with polysulphone but not polyamide membranes may acutely increase aPWV, probably due to membrane bioincompatibility.…”

mentioning

confidence: 99%

Acute vs chronic volume overload on arterial stiffness in haemodialysis patients

Lin

Chen

2005

J Hum Hypertens

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“…2 Changes in the mechanical characteristics of the vascular wall and endothelial dysfunction of large arteries are common in renal failure, which contributes to the increase in cardiovascular morbidity and mortality. [3][4][5] While the prevalence of coronary artery disease in the general population is 5% in the 45-67 age group and 12% in people over 65, it is 40% in ESRD patients, 42% in HD patients, and 32% in peritoneal dialysis patients. [6][7][8][9] Arterial stiffness increases left ventricular load through high systolic blood pressure (SBP) and leads to cardiac hypertrophy.…”

Section: Introductionmentioning

confidence: 99%

Factors Related to Pulse Wave Velocity and Augmentation Index in Chronic Hemodialysis Patients

et al. 2011

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Background: Augmentation index (AIx) and pulse wave velocity (PWV) are early markers of atherosclerotic vascular changes and also have been shown to be predictive of cardiovascular disease and total mortality. The aim of our study was to evaluate the relationship between PWV and AIx-HR75, which is the corrected form of AIx according to a heart rate of 75 beats/min, echocardiographic parameters and biochemical parameters in chronic hemodialysis (HD) patients. Subjects and methods: AIx-HR75 and PWV were measured in 556 HD patients by applanation tonometry using the SphygmoCor device. Results: The mean PWV and AIx-HR75 values of the study group were 10.2 ± 2.4 and 28.4 ± 10.2 m/s. A positive correlation was found between PWV and AIx-HR75 (r = 0.214, p = 0.000). AIx-HR75 correlated with age (r = 0.093, p = 0.028), body surface area (BSA) (r = −0.194, p = 0.000), mean arterial pressure (MAP) (r = 0.335, p = 0.000), pulse pressure (PP) (r = 0.212, p = 0.000), cardiothoracic index (r = 0.155, p = 0.016), and presence of left ventricular hypertrophy (r = 0.152, p = 0.001). PWV correlated with MAP (r = 0.208, p = 0.000), PP (r = 0.098, r = 0.021), left ventricular mass (r = 0.105, p = 0.023), and predialysis sodium level (r = −0.105, p = 0.023). In the multivariate analyses, PWV was associated with MAP (t = 3.78, p = 0.000), presence of diabetes (t = 3.20, p = 0.001), and predialysis sodium level (t = −2.06, p = 0.040), and AIx-HR75 was associated with age (t = 2.48, p = 0.014), female sex (t = 3.98, p = 0.000), BSA (t = −2.15, p = 0.033), and MAP (t = 7.02, p = 0.000). Conclusion: There is a strong association between MAP and arterial stiffness parameters in HD patients. We feel that efficient control of blood pressure could lead to reduced arterial stiffness in HD patients.

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Acute effects of haemodialysis on endothelial function and large artery elasticity

Abstract: Haemodialysis per se did not have a significant effect on endothelial function or large artery mechanical vessel wall properties in patients on maintenance dialysis therapy.

Cited by 61 publications

References 22 publications

Ultrafiltration improves aortic compliance in haemodialysis patients

Ultrafiltration improves aortic compliance in haemodialysis patients

Acute vs chronic volume overload on arterial stiffness in haemodialysis patients

Factors Related to Pulse Wave Velocity and Augmentation Index in Chronic Hemodialysis Patients

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