Fluid Overload, Pulse Wave Velocity, and Ratio of Brachial Pre-Ejection Period to Ejection Time in Diabetic and Non-Diabetic Chronic Kidney Disease

Tsai, Yi‐Chun; Chiu, Yi‐Wen; Kuo, Hung-Tien; Chen, Szu-Chia; Hwang, Shiuh-Lin; Chen, Tzu-Hui; Kuo, Mei‐Chuan; Chen, Hung‐Chun

doi:10.1371/journal.pone.0111000

Cited by 9 publications

(6 citation statements)

References 32 publications

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“…Patients with cardiomegaly are susceptible to albuminuria, anemia, and fluid overload 15,16 . Fluid overload has been independently associated with rapid renal function deterioration and a high risk of cardiovascular burden 24–26 . To the best of our knowledge, the relationship between cardiomegaly and rapid renal progression remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Increased Aortic Arch Calcification and Cardiomegaly is Associated with Rapid Renal Progression and Increased Cardiovascular Mortality in Chronic Kidney Disease

Chen

Teh

Huang

et al. 2019

Sci Rep

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Vascular calcification and cardiomegaly are highly prevalent in chronic kidney disease (CKD) patients. However, the association of the combination of aortic arch calcification (AoAC) and cardio-thoracic ratio (CTR) with clinical outcomes in patients with CKD is not well investigated. This study investigated whether the combination of AoAC and CTR is associated with poor clinical outcomes in CKD stages 3–5 patients. We enrolled 568 CKD patients, and AoAC and CTR were determined by chest radiography at enrollment. Rapid renal progression was defined as estimated glomerular filtration rate (eGFR) decline over 3 ml/min/1.73 m 2 per year. Both AoAC score and CTR were significantly associated with rapid renal progression. High CTR was correlated with increased risk for cardiovascular mortality. We stratified the patients into four groups according to the median AoAC score of 4 and CTR of 50%. Those with AoAC ≥ 4 and CTR ≥ 50% ( vs . AoAC score < 4 and CTR < 50%) were associated with eGFR decline over 3 ml/min/1.73 m 2 /year and cardiovascular mortality. AoAC and CTR were independently associated with eGFR slope. In conclusion, the combination of increased AoAC and cardiomegaly was associated with rapid renal progression and increased cardiovascular mortality in patients with CKD stage 3–5 patients. We suggest that evaluating AoAC and CTR on chest plain radiography may be a simple and inexpensive method for detecting CKD patients at high risk for adverse clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Increased Aortic Arch Calcification and Cardiomegaly is Associated with Rapid Renal Progression and Increased Cardiovascular Mortality in Chronic Kidney Disease

Chen

Teh

Huang

et al. 2019

Sci Rep

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“…Our study highlights the need for an optimal strategy for volume management in CKD patients in clinical practice. Tsai et al [9,25] measured the fluid status and the other clinical variables only once at enrollment; with such a study design, the effect of timevarying fluid status and the other clinical variables on renal progression may be underestimated. In contrast, we conducted a prospective study of 1-year duration, measuring fluid and renal status 3 times during the study period.…”

Section: Discussionmentioning

confidence: 99%

Effect of Strict Volume Control on Renal Progression and Mortality in Non-Dialysis-Dependent Chronic Kidney Disease Patients: A Prospective Interventional Study

et al. 2018

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Objective: The aim of this study was to examine the effect of volume status on the progressions of renal disease in normovolemic and hypervolemic patients with advanced non-dialysis-dependent chronic kidney disease (CKD) who were apparently normovolemic in conventional physical examination. Materials and Methods: This was a prospective interventional study performed in a group of stage 3–5 CKD patients followed up for 1 year. Three measurements were made for volume and renal status for every patient. The fluid status was assessed by a bioimpedance spectroscopy method. A blood pressure (BP) value > 130/80 mm Hg prompted the initiation or dose increment of diuretic treatment in normovolemic patients. Result: Forty-eight patients (48%) were hypervolemic. At the end of the 1-year follow-up, hypervolemic patients were found to have a significantly lower estimated glomerular filtration rate and higher systolic BP compared to baseline. Hypervolemia was associated with an increased incidence of death. Conclusion: We have shown that maintenance of normovolemia with diuretic therapy in normovolemic patients was able to slow down and even improve the progression of renal disease. Volume overload leads to an increased risk for dialysis initiation and a decrease in renal function in advanced CKD. Volume overload exhibits a stronger association with mortality in CKD patients.

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“…PEP can be considered as a measure of left ventricular function, as it reflects changes in the contractility of myocardium, left ventricular end-diastolic volume, and aortic diastolic pressure [ 13 , 16 – 18 ]. In patients with diabetic chronic kidney disease, fluid overload is a marker for left ventricular systolic dysfunction and is associated with the ratio of brachial PEP and brachial ejection time [ 19 ]. Physical activity, as well as respiration or a stress response, can rapidly change the PEP [ 20 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

Small intra-individual variability of the pre-ejection period justifies the use of pulse transit time as approximation of the vascular transit

Kortekaas¹,

Velzen²,

Grüne³

et al. 2018

PLoS ONE

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BackgroundVascular transit time (VTT) is the propagation time of a pulse wave through an artery; it is a measure for arterial stiffness. Because reliable non-invasive VTT measurements are difficult, as an alternative we measure pulse transit time (PTT). PTT is defined as the time between the R-wave on electrocardiogram and arrival of the resulting pulse wave in a distal location measured with photoplethysmography (PPG). The time between electrical activation of the ventricles and the resulting pulse wave after opening of the aortic valve is called the pre-ejection period (PEP), a component of PTT. The aim of this study was to estimate the variability of PEP at rest, to establish how accurate PTT is as approximation of VTT.MethodsPTT was measured and PEP was assessed with echocardiography (gold standard) in three groups of 20 volunteers: 1) a control group without cardiovascular disease aged <50 years and 2) aged >50 years, and 3) a group with cardiovascular risk factors, defined as arterial hypertension, dyslipidemia, kidney failure and diabetes mellitus.ResultsPer group, the mean PEP was: 1) 58.5 ± 13.0 ms, 2) 52.4 ± 11.9 ms, and 3) 57.6 ± 11.6 ms. However, per individual the standard deviation was much smaller, i.e. 1) 2.0–5.9 ms, 2) 2.8–5.1 ms, and 3) 1.6–12.0 ms, respectively. There was no significant difference in the mean PEP of the 3 groups (p = 0.236).ConclusionIn conclusion, the intra-individual variability of PEP is small. A change in PTT in a person at rest is most probably the result of a change in VTT rather than of PEP. Thus, PTT at rest is an easy, non-invasive and accurate approximation of VTT for monitoring arterial stiffness.

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Fluid Overload, Pulse Wave Velocity, and Ratio of Brachial Pre-Ejection Period to Ejection Time in Diabetic and Non-Diabetic Chronic Kidney Disease

Cited by 9 publications

References 32 publications

Increased Aortic Arch Calcification and Cardiomegaly is Associated with Rapid Renal Progression and Increased Cardiovascular Mortality in Chronic Kidney Disease

Increased Aortic Arch Calcification and Cardiomegaly is Associated with Rapid Renal Progression and Increased Cardiovascular Mortality in Chronic Kidney Disease

Effect of Strict Volume Control on Renal Progression and Mortality in Non-Dialysis-Dependent Chronic Kidney Disease Patients: A Prospective Interventional Study

Small intra-individual variability of the pre-ejection period justifies the use of pulse transit time as approximation of the vascular transit

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