Clinical Centre of Serbia, Department of Nephrology, 11000 Belgrade, Serbia.
School of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
Medicina (Kaunas). 2020 Aug 28;56(9):435. doi: 10.3390/medicina56090435.
Abnormal arterial stiffness (AS) is a major complication in end-stage kidney disease (ESKD) patients treated by dialysis. Our study aimed to determine the significance of AS for survival of prevalent dialysis patients, as well as its association with cardiovascular parameters or vascular calcification promoters/inhibitors or both and AS.
The study involved 80 adult hemodialysis patients. Besides standard laboratory analyses, we also determined promoters and inhibitors of vascular calcification (bone biomarkers): serum levels of fibroblast growth factor 23 (FGF23), soluble Klotho, intact parathormone (iPTH), 1,25-dihydroxyvitamin D3, osteoprotegerin, sclerostin, AS measured as ankle carotid pulse wave velocity (acPWV), Ankle Brachial Index (ABI), and vascular calcification (VC) score. Patients were monitored for up to 28 months. According to the median acPWV value, we divided patients into a group with acPWV ≤ 8.8 m/s, and a group with acPWV > 8.8 m/s, and the two groups were compared.
Values for bone biomarkers were similar in both groups. Mean arterial blood pressure (MAP), central systolic and diastolic brachial blood pressure, heart rate, and pulse pressure were higher in the group with acPWV > 8.8 m/s than in the group with acPWV ≤ 8.8 m/s. The mortality was higher for patients with acPWV > 8.8 m/s at any given time over 28 months of follow-up. In multivariable analysis, predictors of higher acPWV were age >60.5, higher pulse rate, and higher central systolic or brachial diastolic blood pressure.
According to our results, we advise the measurement of acPWV preferentially in younger dialysis patients for prognosis, as well as intervention planning before the development of irreversible changes in blood vessels. In addition, measuring central systolic blood pressure seems to be useful for monitoring AS in prevalent hemodialysis patients.
异常的动脉僵硬度（AS）是接受透析治疗的终末期肾病（ESKD）患者的主要并发症。本研究旨在确定 AS 对现患透析患者生存的意义，以及其与心血管参数或血管钙化促进剂/抑制剂或两者的关系，以及与 AS 的关系。
本研究纳入了 80 名成年血液透析患者。除了标准实验室分析外，我们还测定了血管钙化的促进剂和抑制剂（骨生物标志物）：血清成纤维细胞生长因子 23（FGF23）、可溶性 Klotho、完整甲状旁腺激素（iPTH）、1,25-二羟维生素 D3、骨保护素、骨硬化蛋白水平。对患者进行了长达 28 个月的监测。根据 acPWV 的中位数，我们将患者分为 acPWV≤8.8m/s 组和 acPWV>8.8m/s 组，并对两组进行比较。
两组的骨生物标志物值相似。acPWV>8.8m/s 组的平均动脉压（MAP）、中心收缩压和舒张压、心率和脉压均高于 acPWV≤8.8m/s 组。在 28 个月的随访中，任何给定时间 acPWV>8.8m/s 患者的死亡率均较高。多变量分析显示，acPWV 较高的预测因素为年龄>60.5 岁、脉搏率较高、中心收缩压或肱动脉舒张压较高。
根据我们的结果，我们建议在年轻的透析患者中优先测量 acPWV，以预测预后，并在血管不可逆变化发生之前进行干预规划。此外，测量中心收缩压似乎对监测现患血液透析患者的 AS 有用。
