Öğünç Handan, Akdam Hakan, Alp Alper, Gencer Fatih, Akar Harun, Yeniçerioğlu Yavuz
Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey.
Department of Internal Medicine, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey.
Hemodial Int. 2015 Jul;19(3):463-71. doi: 10.1111/hdi.12277. Epub 2015 Feb 4.
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.
血液透析患者动脉僵硬度增加是心血管疾病发病率和死亡率的有力预测指标。脉搏波速度（PWV）和增强指数（AIx）作为动脉僵硬度的标志物，被用于无创性地确定血管损伤的严重程度。本研究旨在探讨单次血液透析过程中溶质清除量和血流动力学变化对PWV和AIx的影响。30名血液透析患者纳入本研究。在血液透析开始前、透析过程中每隔15分钟以及透析结束后30分钟，测量每位患者的PWV和AIx@75（以心率75次/分钟进行标准化）。在血液透析开始前和结束后30分钟，通过生物电阻抗光谱仪分析身体成分。在血液透析过程中，未观察到AIx@75有显著变化。然而，透析过程中PWV稳步下降，在第135分钟达到统计学显著水平（P = 0.026），在第210分钟下降幅度最大（P < 0.001）。在第210分钟时，PWV的下降与中心收缩压、中心舒张压、中心脉压、增强压和AIx@75的下降呈正相关。多元回归分析显示，第210分钟时PWV的下降与中心收缩压和中心脉压的下降有关。血液透析过程中的超滤对PWV和AIx@75无显著影响。第240分钟时，尿素变化量与PWV变化量呈正相关。血液透析过程中观察到PWV显著下降且与尿素清除相关；然而，我们未能证明清除量对动脉僵硬度有任何影响。
