Improvement in Central Arterial Pressure Waveform during Hemodialysis Is Related to a Reduction in Asymmetric Dimethylarginine (ADMA) Levels

Soveri, Inga; Lind, Lars; Wíkström, Björn; Zilmer, Mihkel; Zilmer, Kersti; Fellström, Bengt

doi:10.1159/000104429

Cited by 18 publications

(13 citation statements)

References 56 publications

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“…That study revealed that hemodialysis improved central arterial pressure waveform characteristics by reducing wave reflections from the periphery [10]. These results were confirmed in two subsequent studies, which consistently showed significant reductions in AIx levels between the start and the end of a standard mid-week dialysis session [11,19]. However, all these studies are rather limited by the absence of a simultaneous determination of aortic PWV.…”

Section: Discussionmentioning

confidence: 74%

Hemodialysis Reduces Augmentation Index but Not Aortic or Brachial Pulse Wave Velocity in Dialysis-Requiring Patients

Georgianos

Sarafidis²,

Malindretos³

et al. 2011

Am J Nephrol

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Background/Aims: Arterial stiffening characterizes the vasculature of end-stage renal disease (ESRD) patients and is a strong predictor of their cardiovascular morbidity and mortality. Previous studies evaluating the effect of hemodialysis on large artery elasticity gave contradictory results. This study aimed to investigate the impact of hemodialysis on arterial stiffness and wave reflections on chronic hemodialysis patients. Methods: A total of 51 stable ESRD patients on maintenance hemodialysis were evaluated before and after the first and second dialysis session of the week. Arterial stiffness was assessed by measuring aortic and brachial pulse wave velocity (PWV). Central arterial pressure waveform parameters were estimated by radial artery applanation tonometry. Heart rate-adjusted augmentation index [AIx(75)] was used as measure of wave reflections. Results: During both dialysis sessions systolic blood pressure (SBP) and pulse pressure (PP) at brachial artery and central aorta were reduced. AIx(75) was decreased in first and second weekly dialysis session (27.5 ± 1.2 vs. 21.0 ± 1.5, p < 0.001 and 24.7 ± 1.2 vs. 20.5 ± 1.5, p < 0.001, respectively). In contrast, aortic and brachial PWV remained unchanged during both dialysis sessions. Changes in AIx(75) during hemodialysis were associated with changes in central aortic SBP, PP and ejection duration. Conclusions: This study shows that hemodialysis does not acutely affect arterial stiffness, but reduces wave reflections from periphery. This dissociation between effects of hemodialysis on PWV and AIx(75) may reflect differential impact on large and small branches of the arterial tree.

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Section: Discussionmentioning

confidence: 74%

Hemodialysis Reduces Augmentation Index but Not Aortic or Brachial Pulse Wave Velocity in Dialysis-Requiring Patients

Georgianos

Sarafidis²,

Malindretos³

et al. 2011

Am J Nephrol

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“…An improvement in endothelial functions and a decrease in PWV were detected as a result of an increased clearance of endogenous nitric oxide synthetase inhibitor asymmetric dimethylarginine with dialysis . Similarly, the decrease in asymmetric dimethylarginine levels after hemodialysis was found to be associated with the improvement in central arterial pressure wave and that nitric oxide might have a role in regulating arterial stiffness …”

Section: Discussionmentioning

confidence: 90%

“…The studies in the literature have designed to measure PWV before and at the end of the dialysis session . There is no study in the literature that evaluated the changes in PWV and AIx during the dialysis session.…”

Section: Discussionmentioning

confidence: 99%

The effects of single hemodialysis session on arterial stiffness in hemodialysis patients

Öğünç

Akdam

Alp

et al. 2015

Hemodialysis International

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Increased arterial stiffness in hemodialysis patients is a strong predictor of cardiovascular morbidity and mortality. Pulse wave velocity (PWV) and augmentation index (AIx), which are markers of arterial stiffness, were used to determine the severity of vascular damage noninvasively. This study aimed to investigate the effects of solute volume removal and hemodynamic changes on PWV and AIx of a single hemodialysis session. Thirty hemodialysis patients were enrolled in the study. Before initiation of hemodialysis, every 15 minutes during hemodialysis, and 30 minutes after the completion of the session, measurements of PWV and AIx@75 (normalized with heart rate 75 bpm) were obtained from each patient. Body composition was analyzed by bioimpedance spectroscopy device before and 30 minutes after completion of the hemodialysis session. During the hemodialysis, no significant change was observed in AIx@75. However, PWV decreased steadily during the session reaching statistically significant level at 135th minute (P = 0.026), with a maximal drop at 210th minute (P < 0.001). At 210th minute, decrease in PWV correlated positively with the decrease in central systolic blood pressure, central diastolic blood pressure, central pulse pressure, augmentation pressure, and AIx@75. Multiple regression analysis showed that decrease in PWV at 210th minute was associated with decrease in central systolic blood pressure and central pulse pressure. Ultrafiltration during hemodialysis had no significant effect on PWV and AIx@75. Delta urea correlated positively with delta PWV at 240th minute. A significant decrease in PWV was observed during hemodialysis and correlated with urea reduction; however, we were unable to document any effect of volume removal on arterial stiffness.

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“…We identified 19 studies in which the impact of a single HD session on the clearance of ADMA was analyzed [1, 8, 13,27,28,29,30,31,33,34,35,39,40,41,42,43, 59, 62, 63]. The studies included 245 patients; in 10 studies reduction of SDMA levels was also analyzed.…”

Section: Resultsmentioning

confidence: 99%

Asymmetrical Dimethylarginine in Renal Disease: Limits of Variation or Variation Limits?

Jacobi

Tsao

2007

Am J Nephrol

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Asymmetrical dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, is increasingly recognized as a putative biomarker in cardiovascular and renal disease. Elevated plasma levels of ADMA are the consequence of increased synthesis, reduced renal clearance or reduced enzymatic degradation. Based upon the metabolic fate the highest plasma concentrations of ADMA have been reported in patients with renal failure in whom this molecule accumulates. However, the range of published ADMA levels in patients with chronic renal failure as well as in patients with end-stage renal failure undergoing maintenance hemodialysis, peritoneal dialysis or kidney transplant recipients is widely scattered and overlaps with the levels reported in healthy individuals. This wide distribution can in part be explained by different bioanalytical techniques and the lack of standardization of such assays. This review summarizes available literature on ADMA in patients with kidney disease and stresses the urgent need for a consensus regarding reference values for different analytical methods in order to appreciate the prognostic significance of elevated ADMA levels. At present, one cannot advocate this molecule for risk assessment or individual patient prognosis in the clinical work-up of patients with renal impairment.

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Improvement in Central Arterial Pressure Waveform during Hemodialysis Is Related to a Reduction in Asymmetric Dimethylarginine (ADMA) Levels

Cited by 18 publications

References 56 publications

Hemodialysis Reduces Augmentation Index but Not Aortic or Brachial Pulse Wave Velocity in Dialysis-Requiring Patients

Hemodialysis Reduces Augmentation Index but Not Aortic or Brachial Pulse Wave Velocity in Dialysis-Requiring Patients

The effects of single hemodialysis session on arterial stiffness in hemodialysis patients

Asymmetrical Dimethylarginine in Renal Disease: Limits of Variation or Variation Limits?

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