Erdan Alper, Ozkok Abdullah, Alpay Nadir, Akkaya Vakur, Yildiz Alaattin
1 Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
2 Department of Nephrology, Istanbul Umraniye Training and Research Hospital, Saglik Bilimleri University, Istanbul, Turkey.
Int J Artif Organs. 2018 Jul;41(7):378-384. doi: 10.1177/0391398818778212. Epub 2018 May 28.
Arterial stiffness is a strong predictor of mortality in hemodialysis patients. In this study, we aimed to investigate possible relations of arterial stiffness with volume status determined by bioimpedance analysis and aortic blood pressure parameters. Also, effects of a single hemodialysis session on these parameters were studied.
A total of 75 hemodialysis patients (M/F: 43/32; mean age: 53 ± 17) were enrolled. Carotid-femoral pulse wave velocity, augmentation index, and aortic pulse pressure were measured by applanation tonometry before and after hemodialysis. Extracellular fluid and total body fluid volumes were determined by bioimpedance analysis.
Carotid-femoral pulse wave velocity (9.30 ± 3.30 vs 7.59 ± 2.66 m/s, p < 0.001), augmentation index (24.52 ± 9.42 vs 20.28 ± 10.19, p < 0.001), and aortic pulse pressure (38 ± 14 vs 29 ± 8 mmHg, p < 0.001) significantly decreased after hemodialysis. Pre-dialysis carotid-femoral pulse wave velocity was associated with age (r = 0.15, p = 0.01), total cholesterol (r = 0.06, p = 0.02), peripheral mean blood pressure (r = 0.10, p = 0.005), aortic-mean blood pressure (r = 0.06, p = 0.02), aortic pulse pressure (r = 0.14, p = 0.001), and extracellular fluid/total body fluid (r = 0.30, p < 0.0001). Pre-dialysis augmentation index was associated with total cholesterol (r = 0.06, p = 0,02), aortic-mean blood pressure (r = 0.16, p < 0.001), and aortic pulse pressure (r = 0.22, p < 0.001). Δcarotid-femoral pulse wave velocity was associated with Δaortic-mean blood pressure (r = 0.06, p = 0.02) and inversely correlated with baseline carotid-femoral pulse wave velocity (r = 0.29, p < 0.001). Pre-dialysis Δaugmentation index was significantly associated with Δaortic-mean blood pressure (r = 0.09, p = 0.009) and Δaortic pulse pressure (r = 0.06, p = 0.03) and inversely associated with baseline augmentation index (r = 0.14, p = 0.001). In multiple linear regression analysis (adjusted R = 0.46, p < 0.001) to determine the factors predicting Log carotid-femoral pulse wave velocity, extracellular fluid/total body fluid and peripheral mean blood pressure significantly predicted Log carotid-femoral pulse wave velocity (p = 0.001 and p = 0.006, respectively).
Carotid-femoral pulse wave velocity, augmentation index, and aortic pulse pressure significantly decreased after hemodialysis. Arterial stiffness was associated with both peripheral and aortic blood pressure. Furthermore, reduction in arterial stiffness parameters was related to reduction in aortic blood pressure. Pre-dialysis carotid-femoral pulse wave velocity was associated with volume status determined by bioimpedance analysis. Volume control may improve not only the aortic blood pressure measurements but also arterial stiffness in hemodialysis patients.
动脉僵硬度是血液透析患者死亡率的有力预测指标。在本研究中，我们旨在探讨动脉僵硬度与通过生物电阻抗分析测定的容量状态及主动脉血压参数之间的可能关系。此外，还研究了单次血液透析治疗对这些参数的影响。
共纳入75例血液透析患者（男/女：43/32；平均年龄：53±17岁）。采用压平式眼压计在血液透析前后测量颈股脉搏波速度、增强指数和主动脉脉压。通过生物电阻抗分析测定细胞外液和总体液量。
血液透析后，颈股脉搏波速度（9.30±3.30 vs 7.59±2.66 m/s，p<0.001）、增强指数（24.52±9.42 vs 20.28±10.19，p<0.001）和主动脉脉压（38±14 vs 29±8 mmHg，p<0.001）显著降低。透析前颈股脉搏波速度与年龄（r=0.15，p=0.01）、总胆固醇（r=0.06，p=0.02）、外周平均血压（r=0.10，p=0.005）、主动脉平均血压（r=0.06，p=0.02）、主动脉脉压（r=0.14，p=0.001）以及细胞外液/总体液（r=0.30，p<0.0001）相关。透析前增强指数与总胆固醇（r=0.06，p=0.02）、主动脉平均血压（r=0.16，p<0.001）和主动脉脉压（r=0.22，p<0.001）相关。颈股脉搏波速度变化量与主动脉平均血压变化量相关（r=0.06，p=0.02），且与基线颈股脉搏波速度呈负相关（r=0.29，p<0.001）。透析前增强指数变化量与主动脉平均血压变化量（r=0.09，p=0.009）和主动脉脉压变化量（r=0.06，p=0.03）显著相关，且与基线增强指数呈负相关（r=0.14，p=0.001）。在确定预测颈股脉搏波速度对数的因素的多元线性回归分析中（调整R=0.46，p<0.001），细胞外液/总体液和外周平均血压显著预测颈股脉搏波速度对数（分别为p=0.001和p=0.006）。
血液透析后颈股脉搏波速度、增强指数和主动脉脉压显著降低。动脉僵硬度与外周血压和主动脉血压均相关。此外，动脉僵硬度参数的降低与主动脉血压的降低有关。透析前颈股脉搏波速度与通过生物电阻抗分析测定的容量状态相关。容量控制可能不仅改善主动脉血压测量值，还能改善血液透析患者的动脉僵硬度。
