Level C, Lasseur C, Delmas Y, Cazin M C, Vendrely B, Chauveau P, Gosse P, Combe C
Service de Néphrologie et Hémodialyse, Hôpital Saint André, Bordeaux, France.
Clin Nephrol. 2001 Dec;56(6):435-44.
Cardiovascular disease is the principal cause of morbidity and mortality among hemodialysis patients. Several studies have demonstrated the importance of a reduction in arterial compliance in the development of cardiovascular complications, reflecting the interaction of functional and structural alterations of the peripheral arterial system and left ventricle. The aim of the present study was to demonstrate that arterial compliance, evaluated by automated recording of the QKd interval, was lower in hemodialysis patients than in normal subjects. A secondary objective of the study was to assess the influence of several factors, including calcium-phosphorus parameters, on decreased arterial compliance in these patients.
Arterial compliance was evaluated in 24 chronic hemodialysis patients who had normal (n = 12) or high blood pressure (n = 12), using a method of measuring systolic wave velocity by automated recording of the QKd interval. This interval corresponds to the time (in ms) between the onset of the electrocardiogram QRS complex (Q) and the Korotkoff (K) sound at diastolic pressure (d) heard over the brachial artery during blood pressure measurement. The analysis was performed in comparison with reference values obtained in a population with normal renal function. The other parameters determined were: age, duration of chronic renal failure, duration of hemodialysis therapy, left ventricular mass, vascular calcification score, serum total and ionized calcium, phosphorus, parathyroid hormone, calcidiol, calcitriol, and blood concentration of hemoglobin.
The arterial stiffness of all the patients was increased significantly (p < 0.001) compared to reference values obtained from subjects without renal failure, the average age, height, and blood pressure of whom were similar to those of the patients. Multivariate analysis demonstrated a positive relationship among the QKd interval, serum total calcium, and the duration of hemodialysis. This suggested that arterial wall elastic properties were dependent not only on hypertension and constraints of pressure, but that they were also influenced by calcium and phosphorus metabolism and the duration of renal substitution therapy.
Arterial compliance, evaluated by the ambulatory method of QKd measurement, is reduced in chronic hemodialysis patients, and is inversely correlated with serum calcium concentration and dependent on the previous duration of hemodialysis therapy.
心血管疾病是血液透析患者发病和死亡的主要原因。多项研究表明，动脉顺应性降低在心血管并发症的发生发展中具有重要作用，这反映了外周动脉系统和左心室功能及结构改变之间的相互作用。本研究的目的是证明通过自动记录QKd间期评估的动脉顺应性在血液透析患者中低于正常受试者。该研究的次要目的是评估包括钙磷参数在内的多种因素对这些患者动脉顺应性降低的影响。
使用通过自动记录QKd间期测量收缩波速度的方法，对24例患有正常血压（n = 12）或高血压（n = 12）的慢性血液透析患者的动脉顺应性进行评估。该间期对应于在血压测量期间，心电图QRS波群起始（Q）与在肱动脉听到的舒张压（d）时的柯氏音（K）之间的时间（以毫秒为单位）。分析是与在肾功能正常人群中获得的参考值进行比较。测定的其他参数包括：年龄、慢性肾衰竭持续时间、血液透析治疗持续时间、左心室质量、血管钙化评分、血清总钙和离子钙、磷、甲状旁腺激素、骨化二醇、骨化三醇以及血红蛋白的血液浓度。
与从无肾衰竭受试者获得的参考值相比，所有患者的动脉僵硬度均显著增加（p < 0.001），这些受试者的平均年龄、身高和血压与患者相似。多因素分析显示QKd间期、血清总钙和血液透析持续时间之间呈正相关。这表明动脉壁弹性特性不仅取决于高血压和压力负荷，还受钙磷代谢以及肾脏替代治疗持续时间的影响。
通过动态测量QKd评估的动脉顺应性在慢性血液透析患者中降低，且与血清钙浓度呈负相关，并取决于先前的血液透析治疗持续时间。
