Hemodialysis decreases carotid‐brachial and carotid‐femoral pulse wave velocities: A 5‐year follow‐up study

Abstract

Aortic stiffness is a prognostic parameter associated with patient mortality. Vascular access creation has been shown to have effects on arterial stiffness both in the aorta and in the upper limb arteries in chronically hemodialyzed patients (CHPs). However, no longitudinal studies have been conducted in order to characterize the evolution of arterial stiffness in CHPs. The aims of this work were (a) to measure baseline pulse wave velocity (PWV) in the carotid-femoral and in right and left carotid-brachial pathways in a cohort of CHP and (b) to conduct a 5-year prospective study on the same cohort to determine possible time-related differences. Pulse wave velocity was measured both in the carotid-femoral and in the carotid-brachial pathways, and clinical and biochemical parameters were collected in 25 CHPs, which were followed up after a 5-year lapse. Right and left carotid-brachial pathway PWV values showed significant decreases after the 5-year follow-up, independently of the presence of the vascular access (P < 0.001). Additionally, baseline carotid-brachial PWV was significantly higher (P < 0.001) than values measured 5 years later for upper limbs with vascular access (11.97 ± 2.97 m/sec vs. 6.76 ± 1.48 m/sec, respectively) and without vascular access (12.25 ± 2.38 m/sec vs. 7.18 ± 1.88 m/sec, respectively). Similarly, PWV values in the carotid-femoral pathway decreased significantly (P < 0.001) over the same period (13.27 ± 2.96 m/sec vs. 9.75 ± 2.99 m/sec, respectively). The 5-year follow-up of PWV showed significant decreases in both carotid-brachial and carotid-femoral pathways. The general changes in arterial stiffness could be related to the vascular access creation, hemodialysis therapy, and to the improvement of arterial pressure management.

Arterial Stiffness and Renal Replacement Therapy: A Controversial Topic

“…This distinct response to hemodialysis was not observed in a five-year follow-up of 25 hemodialyzed patients carried out by our group (Argentina and Uruguay), in which a significant decrease of carotid-femoral pulse wave velocity was demonstrated [ 15 ].…”

The Novel Bone Alkaline Phosphatase Isoform B1x Is Associated with Improved 5-Year Survival in Chronic Kidney Disease

“…Several longitudinal studies have determined the change of PWV in dialysis patients. Most studies reported a regression of PWV over time [44][45][46][47], whereas Utescu et al [48] described an association of carotid-femoral PWV progression, with decreased carotid-brachial PWV, indicating possible differences between these vascular beds. It has been suggested that therapeutic interventions that can reduce ALP and bone turnover, e.g., treatment with cinacalcet or vitamin D and parathyroidectomy, have the potential to improve arterial stiffness [47,49,50].…”

Quantitative Vascular Evaluation: From Laboratory Experiments to Point-of-Care Patient (Clinical Approach)

“…In some other studies by us, PWV measurements showed that vascular accesses for hemodialysis in the upper arm cause greater reduction in the carotid-brachial stiffness than those in the forearm, in a gender differences study [ 29 ]. A 5-year prospective study on a group of chronically hemodialyzed patients was also performed [ 30 ] in order to determine possible time-related differences. The results showed significant decreases in both carotid-brachial and carotid-femoral pathways.…”