Alexandrou Maria-Eleni, Loutradis Charalampos, Balafa Olga, Theodorakopoulou Marieta, Tzanis George, Bakaloudi Dimitra, Dimitriadis Chrysostomos, Pateinakis Panagiotis, Gkaliagkousi Eugenia, Papagianni Aikaterini, Sarafidis Pantelis
Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki.
Department of Nephrology, Papageorgiou General Hospital, Thessaloniki.
J Hypertens. 2020 Dec;38(12):2393-2403. doi: 10.1097/HJH.0000000000002574.
Ambulatory pulse-wave velocity (PWV), augmentation pressure, and augmentation index (AIx) are associated with increased cardiovascular events and death in hemodialysis. The intermittent nature of hemodialysis generates a distinct ambulatory pattern, with a progressive increase of augmentation pressure and AIx during the interdialytic interval. No study so far has compared the ambulatory course of central hemodynamics and PWV between peritoneal dialysis and hemodialysis patients.
Thirty-eight patients under peritoneal dialysis and 76 patients under hemodialysis matched in a 1 : 2 ratio for age, sex and dialysis vintage underwent 48-h ambulatory blood pressure (BP) monitoring with the oscillometric Mobil-O-Graph device. Parameters of central hemodynamics [central SBP, DBP and pulse pressure (PP)], wave reflection [AIx, heart rate-adjusted AIx; AIx(75) and augmentation pressure] and PWV were estimated from the 48-h recordings.
Over the total 48-h period, no significant differences were observed between peritoneal dialysis and hemodialysis patients in mean levels of central SBP, DBP, PP, augmentation pressure, AIx, AIx(75) and PWV. However, patients under peritoneal dialysis and hemodialysis displayed different trajectories in all the above parameters over the course of the recording: in peritoneal dialysis patients no differences were noted in central SBP (125.0 ± 19.2 vs. 126.0 ± 17.8 mmHg, P = 0.25), DBP, PP, augmentation pressure (13.0 ± 6.8 vs. 13.7 ± 7. mmHg, P = 0.15), AIx(75) (25.9 ± 6.9 vs. 26.3 ± 7.8%, P = 0.54) and PWV (9.5 ± 2.1 vs. 9.6 ± 2.1 m/s, P = 0.27) from the first to the second 24-h period of the recording. In contrast, hemodialysis patients showed significant increases in all these parameters from the first to second 24 h (SBP: 119.5 ± 14.4 vs. 124.6 ± 15.0 mmHg, P < 0.001; augmentation pressure: 10.9 ± 5.3 vs. 13.1 ± 6.3 mmHg, P < 0.001; AIx(75): 24.7 ± 7.6 vs. 27.4 ± 7.9%, P < 0.001; PWV: 9.1 ± 1.8 vs. 9.3 ± 1.8 m/s, P < 0.001). Peritoneal dialysis patients had numerically higher levels than hemodialysis patients in all the above parameters during all periods studied and especially during the first 24-h.
Central BP, wave reflection indices and PWV during a 48-h recording are steady in peritoneal dialysis but gradually increase in hemodialysis patients. During all studied periods, peritoneal dialysis patients have numerically higher levels of all studied parameters, a fact that could relate to higher cardiovascular risk.
动态脉搏波速度（PWV）、增强压和增强指数（AIx）与血液透析患者心血管事件增加及死亡相关。血液透析的间歇性产生了一种独特的动态模式，在透析间期增强压和AIx逐渐升高。迄今为止，尚无研究比较腹膜透析和血液透析患者中心血流动力学和PWV的动态变化过程。
38例腹膜透析患者和76例血液透析患者按年龄、性别和透析龄1∶2匹配，使用示波法Mobil-O-Graph设备进行48小时动态血压监测。从48小时记录中估算中心血流动力学参数[中心收缩压、舒张压和脉压（PP）]、波反射[AIx、心率校正AIx；AIx(75)和增强压]及PWV。
在整个48小时期间，腹膜透析和血液透析患者在中心收缩压、舒张压、脉压、增强压、AIx、AIx(75)和PWV的平均水平上未观察到显著差异。然而，在记录过程中，腹膜透析和血液透析患者在上述所有参数上呈现不同的变化轨迹：腹膜透析患者在中心收缩压（125.0±19.2 vs. 126.0±17.8 mmHg，P = 0.25）、舒张压、脉压、增强压（13.0±6.8 vs. 13.7±7. mmHg，P = 0.15）、AIx(75)（25.9±6.9 vs. 26.3±7.8%，P = 0.54）和PWV（9.5±2.1 vs. 9.6±2.1 m/s，P = 0.27）从记录的第一个24小时到第二个24小时期间无差异。相比之下，血液透析患者在上述所有参数从第一个24小时到第二个24小时期间均显著升高（收缩压：119.5±14.4 vs. 124.6±15.0 mmHg，P < 0.001；增强压：10.9±5.3 vs. 13.1±6.3 mmHg，P < 0.001；AIx(75)：24.7±7.6 vs. 27.4±7.9%，P < 0.001；PWV：9.1±1.8 vs. 9.3±1.8 m/s，P < 0.001）。在所有研究期间，尤其是在第一个24小时，腹膜透析患者在上述所有参数上的数值均高于血液透析患者。
48小时记录期间，腹膜透析患者的中心血压、波反射指数和PWV保持稳定，而血液透析患者则逐渐升高。在所有研究期间，腹膜透析患者所有研究参数的数值均较高，这一事实可能与较高的心血管风险相关。
