Faculty of Medicine, Mahasarakham University, Mahasarakham, Thailand.
UCL Department for Nephrology, University College London, London, UK.
Int J Artif Organs. 2021 Feb;44(2):85-91. doi: 10.1177/0391398820931109. Epub 2020 Jun 19.
Pulse wave velocity is a measurement of arterial stiffness and associated with increased cardiovascular mortality. Previous reports in peritoneal dialysis have linked increased pulse wave velocity with an expansion in extracellular water. As cardiovascular mortality is increased in peritoneal dialysis patient, we wished to determine whether changes in pulse wave velocity mirrored changes in extracellular water.
We repeated aortic pulse wave velocity and bioimpedance-derived extracellular water measurements in peritoneal dialysis patients attending for assessment of peritoneal membrane function.
Sixty-six patients, 41 males (62.1%), mean age of 66.2 ± 13.9 years, median duration of peritoneal dialysis treatment (14.3 (3.1-31.9) months) had repeated measurement 6.4 (5.8-10.2) months apart, with no significant change in aortic pulse wave velocity (10.1 ± 3.2 to 9.9 ± 2.8 m/s). In univariate analysis, the initial aortic pulse wave velocity was associated with extracellular water (r = 0.26, p = 0.034) and serum N-terminal pro brain-type natriuretic peptide (r = 0.25, p = 0.04), and on follow-up, aortic pulse wave velocity with N-terminal pro brain-type natriuretic peptide (r = 0.31, p = 0.01). Aortic pulse wave velocity increased in 50% of patients, and these patients had greater serum C-reactive protein 3(2-10) versus 2(1-4) mg/L, and ferritin (778(444-1099) versus 585(313-811), p < 0.05), but there were no differences in either absolute or adjusted extracellular water. Both log C-reactive protein (odds ratio 4.7 (95% confidence limits 1.3-17.1), p = 0.019) and prescription of calcium channel blockers (odds ratio 4.9 (95% confidence limits 1.2-19.1), p = 0.024) were independently associated with an increase in aortic pulse wave velocity.
We did not find an independent association between a change in aortic pulse wave velocity and extracellular water, suggesting that changes in aortic stiffness in peritoneal dialysis patients are more complex than simply following changes in extracellular water.
脉搏波速度是动脉僵硬度的测量指标，与心血管死亡率的增加相关。先前在腹膜透析中的报告表明，脉搏波速度的增加与细胞外液的扩张有关。由于腹膜透析患者的心血管死亡率增加，我们希望确定脉搏波速度的变化是否反映了细胞外液的变化。
我们对接受腹膜透析患者的腹膜功能评估的患者进行了重复的主动脉脉搏波速度和生物电阻抗衍生的细胞外液测量。
66 名患者，41 名男性（62.1％），平均年龄为 66.2±13.9 岁，腹膜透析治疗中位时间（14.3（3.1-31.9）个月），相隔 6.4（5.8-10.2）个月重复测量，主动脉脉搏波速度无显著变化（10.1±3.2 至 9.9±2.8m/s）。在单变量分析中，初始主动脉脉搏波速度与细胞外液（r=0.26，p=0.034）和血清 N 末端脑型利钠肽前体（r=0.25，p=0.04）相关，在随访中，主动脉脉搏波速度与 N 末端脑型利钠肽前体相关（r=0.31，p=0.01）。50％的患者的主动脉脉搏波速度增加，这些患者的血清 C 反应蛋白 3（2-10）比 2（1-4）mg/L 和铁蛋白（778（444-1099）比 585（313-811）更高，p<0.05），但绝对或调整后的细胞外液无差异。C 反应蛋白（优势比 4.7（95％置信区间 1.3-17.1），p=0.019）和钙通道阻滞剂的处方（优势比 4.9（95％置信区间 1.2-19.1），p=0.024）均与主动脉脉搏波速度的增加独立相关。
我们没有发现主动脉脉搏波速度变化与细胞外液之间的独立关联，这表明腹膜透析患者主动脉僵硬度的变化比简单地遵循细胞外液的变化更为复杂。
