Noninvasive indices of arterial stiffness in hemodialysis patients

Abstract

The purpose of this study was to evaluate the validity of brachial-ankle pulse wave velocity (baPWV) and the cardio-ankle vascular index (CAVI) as measures of arterial stiffness in hemodialysis (HD) patients. We studied 160 consecutively enrolled HD patients (mean age: 59±13 years; 91 male patients). We measured baPWV and CAVI using a VaSera VS-1000, maximum intima-media thickness (max IMT) of the carotid artery by ultrasonography and blood renal and lipid parameters. As a control, baPWV and CAVI were also measured in age-and gender-matched healthy volunteers. Both baPWV and CAVI were significantly higher in HD patients than in controls (baPWV: 1698 ± 355 vs. 1454 ± 263 cm s À1 , Po0.0001; CAVI: 9.3 ± 1.4 vs. 8.9 ± 1.2, Po0.01). BaPWV correlated positively with age (r ¼0.549, Po0.0001), systolic blood pressure (SBP) (r¼0.510, Po0.0001), diastolic blood pressure (r ¼0.203, Po0.0001), pulse pressure (PP) (r ¼0.499, Po0.0001), Kt V À1 (r ¼0.221, Po0.01), Brinkman index (r ¼0.186, Po0.05) and max IMT (r ¼0.285, Po0.001). CAVI also correlated positively with age (r ¼0.562, Po0.0001), SBP (r ¼0.395, Po0.0001), PP (r ¼0.490, Po0.0001), Kt V À1 (r ¼0.216, Po0.01), Brinkman index (r ¼0.238, Po0.01) and max IMT (r ¼0.280, Po0.001). Multiple regression analysis demonstrated baPWV and CAVI correlated independently with age and SBP. Receiver operating characteristics (ROC) curve analysis demonstrated that baPWV and CAVI had similar power to predict increases in max IMT. We also measured baPWV and CAVI immediately before and after HD, and showed CAVI was influenced by changes in water volume. Both baPWV and CAVI are therefore useful indices of arterial stiffness in HD patients.

Cardio-Ankle Vascular Index (CAVI) as a Novel Indicator of Arterial Stiffness: Theory, Evidence and Perspectives

“…Nakamura et al 32) reported that CAVI is closely associated with cystatin C levels, suggesting a significant role of arterial stiffness in renal insufficiency. Ueyama et al 33) also reported that CAVI is high in hemodialysis patients.…”

“…Izuhara et al 25) reported that CAVI is indepen- , Izuhara 25) , Miyoshi 26) , Horinaka 27) [Sairaku 29) ] Intima media thickness of cervical artery Nakamura 24) , Ibata 22) , Takaki 20,28) , Izuhara 25) , Miyoshi 26) , Okura 36) , Sairaku 29) , Horinaka 27) , Hayashi 38) Chronic kidney disease [Mortality rate in patients with hemodialysis] Izuhara 25) , Kobuzono 30) , Takenaka 31) , Nakamura 32) , Ueyama 33) , Satoh-Asahara 36) [Kato 40) ] Cerebral infarction, Dementia Yamamoto 39) Metabolic syndrome Satoh 55) Diabetes mellitus Ibata 22) , Izuhara 25) , Okura 37) Hypertension Kubozono 21) , Okura 37) , Takaki 42) , Kadota 43) Dyslipidemia Takaki 28) Smoking Kubozono 21) , Noike 62) Obstructive sleep apnea syndrome Kumagai 60) dently associated with the severity of coronary atherosclerosis. Recently, Miyoshi et al 26) also supported a correlation between CAVI and coronary atherosclerosis.…”

The Role of a Novel Arterial Stiffness Parameter, Cardio-Ankle Vascular Index (CAVI), as a Surrogate Marker for Cardiovascular Diseases

“…Several studies about chronic kidney diseases described that CAVI correlated with estimated glomerular filtration rate and cystatine C 30) and that CAVI is high in patients undergoing hemodialysis therapy 30,31) .…”

Values of Cardio-Ankle Vascular Index (CAVI) between Amami Islands and Kagoshima Mainland Among Health Checkup Examinees

“…CAVI was measured by the standardized method using a Vasera VS-1000 or VS-1500 (Fukuda Denshi Co., Ltd, Tokyo, Japan) for the Amami and mainland groups, as described previously 27,31,32) . In brief, a cuff was placed on the right and left ankles and the brachium; electrodes for electrocardiography were attached to both upper arms, and a microphone was placed on the sternal angle for phonocardiography.…”

“…CAVI values are correlated with carotid intima-media thickness 24,25,29,30) . Several studies have revealed a significant relationship between CAVI and the presence and severity of patients with coronary artery disease 31) , hemodialysis 32,33) , and chronic kidney disease 34) . Changes in arterial stiffness following cessation of smoking and application of CAVI have been reported recently 35) ; however, there is little information on the prevalence and geographical variation of high arterial stiffness evaluated by CAVI among the general population.…”