Variability of pulse wave velocity and mortality in chronic hemodialysis patients

Abstract

We have already demonstrated that in chronic hemodialysis (HD) patients, the cyclic variations in both hydration status and blood pressure are responsible for changes in pulse wave velocity (PWV). The aim of this study is to verify whether the cyclic variation of PWV influences mortality in dialysis patients. We studied 167 oligoanuric (urinary output <500 mL/day) patients on chronic standard bicarbonate HD for at least 6 months. They performed 3 HD sessions of 4 hours per week. Patients were classified into 3 groups: normal PWV before and after dialysis (LL); high PWV before and normal PWV after dialysis (HL); and high PWV before and after dialysis (HH). The carotid-femoral PWV was measured with an automated system using the foot-to-foot method. Analysis of variance was used to compare the different groups. The outcome event studied was all-cause mortality and cardiovascular mortality. The PWV values observed were LL in 44 patients (26.3%); HL in 53 patients (31.8%); and HH in 70 patients (41.9%). The 3 groups of patients are homogenous for sex, age, and blood pressure. The HH group had a higher prevalence of (P<0.001) ASCVD. It is interesting that the distribution of patients in the 3 groups is correlated with the basal value of PWV. In fact, when the basal measure of PWV is elevated, there is a higher probability that an HD session cannot reduce PWV (<12 ms). A total of 53 patients (31.7%) died during the follow-up of 2 years: 5 patients in the LL group (11.4%); 16 in the HL group (30.2%); and 32 in the HH group (50.7%) (LL vs. HL, P=0.047; LL vs. HH, P<0.00001; HL vs. HH, P=0.034). We evidence for the first time that different behaviors of PWV in dialysis subjects determine differences in mortality.

A Randomized Trial of Hemodiafiltration and Change in Cardiovascular Parameters

“…LVM, EF, and PWV have all been repeatedly demonstrated to be relevant predictors of cardiovascular morbidity and mortality in patients with ESRD (5)(6)(7)(8)(9). Regression of LVM has also been shown to be associated with a more favorable outcome in this population (10).…”

Daily dialysis reduces pulse wave velocity in chronic hemodialysis patients

“…7 We also showed that different PWV behaviors due to the cyclic changes that were observed during dialysis are related to a difference in mortality in dialysis patients, with higher mortality in the patients with increased PWV before and after HD. 8 Moreover, there was a significant decrease in aortic PWV when a three-times-per-week dialysis schedule was replaced with daily dialysis. In fact, 10% of PWV-HH patients moved to the PWV-HL group, whereas 90% of PWV-HL patients reduced their PWV to below 12 m s À1 after undergoing daily dialysis.…”

“…7 In addition, we observed for the first time that different PWV behaviors during dialysis were associated with different mortality risks. 8 Patients with high PWV values before and after HD had an increased mortality risk, compared with those with low PWV values before and after HD, and those with high pre-dialysis PWV levels and low post-dialysis levels. 8 However, several studies have shown that daily dialysis reduces patient mortality compared with intermittent dialysis (three times per week), improving CV instability, fluid overload, BP, electrolyte balance and poor clinical metabolic conditions.…”

“…8 Patients with high PWV values before and after HD had an increased mortality risk, compared with those with low PWV values before and after HD, and those with high pre-dialysis PWV levels and low post-dialysis levels. 8 However, several studies have shown that daily dialysis reduces patient mortality compared with intermittent dialysis (three times per week), improving CV instability, fluid overload, BP, electrolyte balance and poor clinical metabolic conditions. [9][10][11][12] Our aim is to assess the impact of daily dialysis on cyclic variations of PWV in HD patients.…”

Variação do índice tornozelo-braquial pré e pós-hemodiálise: correlação com água corporal, cálcio do dialisato e sistema nervoso autônomo

“…Albeit reduction of HRV may be related to alterations in cardiovascular 67 structure, it is also associated with changes in hemodynamic profile during hemodialysis 68 [5]. Indeed, changes in HRV have been used to predict hemodynamic instability, [3] and 69 it is also associated with left ventricular hypertrophy [6].…”