Koutroumbas Georgios, Georgianos Panagiotis I, Sarafidis Pantelis A, Protogerou Athanase, Karpetas Antonios, Vakianis Pantelis, Raptis Vassilios, Liakopoulos Vassilios, Panagoutsos Stylianos, Syrganis Christos, Passadakis Ploumis
Hemodialysis Unit, Achillopouleion General Hospital, Volos, Greece.
Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Nephrol Dial Transplant. 2015 Dec;30(12):2046-53. doi: 10.1093/ndt/gfv090. Epub 2015 Apr 28.
Increased arterial stiffness and aortic blood pressure (BP) are independent predictors of cardiovascular outcomes in end-stage renal disease. The 3-day interdialytic interval is associated with elevated risk of cardiovascular morbidity and mortality in haemodialysis. This study investigated differences in ambulatory aortic BP and arterial stiffness between the second and third day of the long interdialytic interval.
Ambulatory BP monitoring with Mobil-O-Graph monitor (IEM, Stolberg, Germany) was performed in 55 haemodialysis patients during a 3-day interval. Mobil-O-Graph records oscillometric brachial BP and pulse waves and calculates aortic BP and augmentation index (AIx) as measure of wave reflections, and pulse wave velocity (PWV) as measure of arterial stiffness.
Ambulatory aortic systolic blood pressure (SBP) and diastolic blood pressure (DBP) were higher during the third versus second interdialytic day (123.6 ± 17.0 versus 118.5 ± 17.1 mmHg, P < 0.001; 81.5 ± 11.8 versus 78 ± 11.9 mmHg, P < 0.001, respectively). Similar differences were noted for brachial BP. Ambulatory AIx and PWV were also significantly increased during the third versus second day (30.5 ± 9.9 versus 28.8 ± 9.9%, P < 0.05; 9.6 ± 2.3 versus 9.4 ± 2.3 m/s, P < 0.001, respectively). Differences between Days 2 and 3 remained significant when day-time and night-time periods were compared separately. Aortic SBP and DBP, AIx and PWV showed gradual increases from the end of dialysis session onwards. Interdialytic weight gain was a strong determinant of the increase in the above parameters.
This study showed significantly higher ambulatory aortic BP, AIx and PWV levels during the third compared with the second interdialytic day. These findings support a novel pathway for increased cardiovascular risk during the third interdialytic day in haemodialysis.
动脉僵硬度增加和主动脉血压（BP）升高是终末期肾病患者心血管结局的独立预测因素。在血液透析中，3天的透析间期与心血管疾病发病率和死亡率风险升高相关。本研究调查了长透析间期第二天和第三天动态主动脉血压及动脉僵硬度的差异。
使用Mobil-O-Graph监测仪（德国斯托尔贝格的IEM公司）对55例血液透析患者进行了为期3天的动态血压监测。Mobil-O-Graph记录示波法肱动脉血压和脉搏波，并计算主动脉血压和作为波反射测量指标的增强指数（AIx），以及作为动脉僵硬度测量指标的脉搏波速度（PWV）。
与透析间期第二天相比，第三天的动态主动脉收缩压（SBP）和舒张压（DBP）更高（分别为123.6±17.0 mmHg对118.5±17.1 mmHg，P<0.001；81.5±11.8 mmHg对78±11.9 mmHg，P<0.001）。肱动脉血压也有类似差异。与第二天相比，第三天的动态AIx和PWV也显著增加（分别为30.5±9.9%对28.8±9.9%，P<0.05；9.6±2.3 m/s对9.4±2.3 m/s，P<0.001）。当分别比较白天和夜间时段时，第2天和第3天之间的差异仍然显著。主动脉SBP和DBP、AIx和PWV从透析结束后开始逐渐升高。透析间期体重增加是上述参数升高的一个重要决定因素。
本研究表明，与透析间期第二天相比，第三天的动态主动脉血压、AIx和PWV水平显著更高。这些发现支持了血液透析患者在透析间期第三天心血管风险增加的新途径。
