scholarly journals P0763A COMPARATIVE STUDY OF ARTERIAL STIFFNESS AND WAVE REFLECTIONS IN DIABETIC AND NON-DIABETIC PATIENTS WITH CKD

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Maria Schoina ◽  
Charalampos Loutradis ◽  
Evangelos Memmos ◽  
Rafael Papadopoulos ◽  
Eleni Intzevidou ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Stiffness ◽  
Augmentation Index ◽  
Diabetic Patients ◽  
Additional Contribution ◽  
Wave Reflections ◽  
Increased Risk ◽  
Stage 4 ◽  
Ckd Stage ◽  
Significant Difference

Abstract Background and Aims Arterial stiffness is associated with increased risk for target-organ damage, cardiovascular events and overall mortality in the general population, patients with diabetes mellitus and patients with chronic kidney disease (CKD) of all stages. This is the first study to evaluate in comparison arterial stiffness and arterial wave reflections in diabetic and non-diabetic patients with CKD. Method This study included 48 diabetic and 48 non-diabetic adult patients (>18 years) with CKD (eGFR: <90 και ≥15mL/min/1.73m2), matched in a 1:1 ratio for age, sex and eGFR within each CKD stage (2, 3a, 3b and 4). All patients underwent carotid-femoral pulse wave velocity (PWV), central blood pressure (BP), and wave reflections measurement with applanation tonometry (Sphygmocor, Atcor Medical, Australia). Results Office systolic and diastolic blood pressure was similar between diabetic and non-diabetic subjects with CKD in total and across CKD stages. Office brachial pulse pressure (PP) was significantly lower in non-diabetics (49.00±8.0 vs 52.67±8.7 mmHg, p= 0.034). Office PWV was marginally higher in diabetics compared with non-diabetics (10.89±2.0 vs 10.06±2.2 m/sec, p=0.056). In CKD stages 2 and 4, no significant difference in PWV between the two groups was noted, but PWV was higher for diabetics in CKD stages 3a (11.28±1.4 vs 9.83±1.5 m/sec, p=0.023) and 3b (11.13±1.9 vs 9.46±1.2 m/sec, p=0.016). Heart-rate-adjusted augmentation index [AIx(HR75)] was higher in diabetic compared with non-diabetic subjects only in CKD stage 4 (32.08±4.2 vs 25.92±6.6%, p=0.013). Conclusion Diabetic CKD patients present higher arterial stiffness than non-diabetic counterparts. The additional contribution of diabetes towards increased arterial stiffness is more prominent in patients with moderately impaired renal function (CKD stage 3a and 3b), whereas at stage 4, PWV was increased independent of diabetes presence.

P200 Arterial stiffness in patients with mild-to-moderate renal impairment

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
A B Md Radzi ◽  
S S Kasim
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Arterial Stiffness ◽  
Medical Center ◽  
Linear Regression Analysis ◽  
Younger Age ◽  
Stage 4 ◽  
Ckd Stage ◽  
Significant Difference ◽  
The Mean

Abstract Background Arterial damage in chronic kidney disease (CKD) is characterized by aortic stiffness. This is seen in elderly patients with advanced CKD. The association between arterial stiffness and early CKD is not well established. Objective: We aimed to study arterial stiffness using pulse wave velocity (PWV) among patients with chronic kidney disease (CKD) stage 2 to 4 and normal renal function in younger-age population. Design and Method: Patients with confirmed CKD stage 2 to 4 were recruited from various clinics from Universiti Teknologi MARA Medical Center, Sungai Buloh, Malaysia from 1st August 2015 until 31st January 2018. Sociodemographic and anthropometric indices were recorded on recruitment. Each patient underwent carotid-femoral (aortic) PWV measurement to determine arterial stiffness. PWV is determined using a one-probe device (SphygmoSore XCEL). Results: 87 patients with CKD stage 2–4 and 87 control patients were recruited. The mean age was 47 ± 5.4 years. CKD patients had a higher mean PWV (7.8 m/s ± 1.7) than healthy controls (5.6 m/s ± 1.0) (p < 0.001, 95% CI –2.59, –1.77). There was significant difference of mean PWV between control (5.6 m/s ± 1.0) and CKD stage 2 (7.6 m/s ± 1.5) (p < 0.001, 95% CI –2.40, –1.49). Our results showed a stepwise increase in PWV from control subjects, CKD stage 2 through stage 4 (p < 0.001). The mean difference of PWV between CKD stage 2 (7.6 m/s, ± 1.5) and stage 4 (9.0 m/s, ± 0.8) was 1.43 (p < 0.001, 95% CI –2.50, -0.35). There was significant difference of mean PWV between diabetes mellitus (DM) (8.2 m/s ± 1.8) and non-DM (7.3 m/s ± 1.3) patients with CKD stage 2–4 (p = 0.022, 95% CI –1.50, –0.12). Mutiple linear regression analysis showed only age (β = 0.078, p = 0.014), mean arterial pressure (MAP) (β = 0.031, p = 0.007) and diuretics usage as the combination antihypertensive medication (β = 0.839, p = 0.018) were independently associated with PWV (r2 = 0.249, p < 0.001). Conclusions: This study shows that arterial stiffness as assessed by PWV occurs early in CKD patient and increased arterial stiffness occurs in parallel with decline of glomerular filtration rate in patients with mild-to-moderate CKD of younger age population.

scholarly journals MON-LB52 Evaluation of Arterial Stiffness in Acromegaly Patients

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
sevil alagüney ◽  
Goknur Yorulmaz ◽  
Toygar Ahmet Kalkan ◽  
Kadir Ugur Mert ◽  
Muhammet Dural ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Stiffness ◽  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Pulse Wave ◽  
Augmentation Index ◽  
Morbidity And Mortality ◽  
Increased Risk ◽  
Study Results ◽  
Blood Pressures

Abstract Acromegaly is associated with increased morbidity and mortality primarily attributed to cardiovascular and cerebrovascular diseases, thus demonstrating the negative arterial impact of chronic GH and IGF-1 excess. There are limited and conflicting data regarding coronary artery disease (CAD) in acromegaly that consists mainly of heterogeneous cohorts and pathological reviews of old case series. Increased arterial stiffness is associated with an increased risk of cardiovascular events such as myocardial infarction. Arterial stiffness may measured from pulse wave velocity(PWV). In this study we aimed to evaluate the association between pulse wave velocity and aortic augmentation index in acromegalic patients. Methods: Our study population consists of a consecutive subset of 32 acromegalic patients and 19 control. Acromegalic patients IGF 1 levels were noted. All patients BMI, age, blood pressure, gender also were noted. Also pulse pressure, central blood pressures were measured by non-invasive central blood pressure measurement device (SphygmoCor). Pulse wave velocity and aortic augmentation index were measured by the same device. Results: A total of 32 acromegalic patients and 19 control were enrolled in the study. Body mass index and gender were not significantly different between the groups. Aortic augmentation index (5 vs. 6, p =0,685) variables weren’t significantly different in the study. Systolic and diastolic blood pressures were significantly high in the acromegalic group. (130/82 vs. 120/70) PWV was significantly high in the acromegalic group. (13 vs 11,5 p=0,002)Conclusions: Our study results suggest that acromegaly patients have worse arterial stiffness due to increased pulse wave velocity. Acromegaly is associated with increased morbidity and mortality primarily attributed to cardiovascular problems. We thought that it may be a guiding method in disease management since it can be an early marker of cardiovascular risk.Keywords: acromegaly, pulse wave velocity, aortic augmentation index

P0156SHORT-TERM BLOOD PRESSURE VARIABILITY IN DIABETIC AND NON-DIABETIC PATIENTS WITH CKD STAGE 2, 3A, 3B AND 4

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Maria Schoina ◽  
Charalampos Loutradis ◽  
Ioanna Minopoulou ◽  
Marieta Theodorakopoulou ◽  
Theodoros Dimitroulas ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Risk Factor ◽  
Blood Pressure Variability ◽  
Diabetic Patients ◽  
Additional Risk Factor ◽  
Night Time ◽  
Stage 4 ◽  
Ckd Stage ◽  
Average Real Variability

Abstract Background and Aims Blood pressure variability (BPV) is an important risk factor for cardiovascular events and mortality in patients with chronic kidney disease (CKD). Previous evidence suggests that BPV is gradually increasing across CKD stages. Whether type 2 diabetes mellitus (DM) is an additional risk factor for increased BPV has never been studied. The aim of this study is to examine in comparison BPV in diabetic and non-diabetic patients with CKD. Method We included 48 diabetic and 48 non-diabetic adult patients (>18 years) with CKD (eGFR: <90 και ≥15mL/min/1.73m2), matched in a 1:1 ratio for age, sex and eGFR within each CKD stage (2, 3a, 3b and 4). All patients underwent 24-hour ambulatory blood pressure (BP) measurement with the Mobil-O-Graph device. Brachial BP variability was calculated with validated formulas. We calculated standard deviation (SD), weighted SD (wSD), coefficient of variation (CV), and average real variability (ARV) of BP during the 24-hour, day- and night-time periods with validated formulas. Results In total population, ambulatory systolic BP (SBP) levels were significantly higher in diabetics compared to non-diabetic counterparts in all studied periods. No significant differences were evidence for ambulatory diastolic BP (DBP) in total or across CKD stages. In total, 24-hour SBP SD (15.43±4.34 vs 13.38±3.35, p=0.011), wSD (14.41±4.11 vs 12.53±3.19, p=0.014) and ARV (10.94±2.75 vs 9.46±2.10, p=0.004) were higher in patients with DM compared to those without DM. In addition, 24hour DBP SD (11.04±2.39 vs 9.80±2.28, p=0.010), wSD (10.30±2.52vs 9.05±1.99, p=0.008), CV (14.77±3.05 vs 13.14±2.96, p=0.009) and ARV (8.23±2.10 vs 7.10±1.33, p=0.002) were again different between groups. Across CKD stages 2 and 3a, BPV indices were insignificantly higher in patients with DM. In CKD Stage 3b, 24-hour SBP-SD (16.30±4.52 vs 11.35±2.62, p=0.003), wSD (15.42±4.54 vs 10.77±2.30, p=0.004), ARV (12.46±3.19 vs 8.34±2.07, p=0.001) and 24-hour DBP-CV (14.84±3.63 vs 12.18±1.91, p=0.035) were higher in diabetic compared to non-diabetic patients. In contrast, no difference between groups existed in CKD Stage 4. Conclusion Patients with DM present increased BPV in CKD Stages 2, 3a and 3b (moderately impaired renal function). This difference is not apparent in patients with advanced CKD at Stage 4.

scholarly journals Effects of menopausal hormone therapy on ambulatory blood pressure and arterial stiffness in postmenopausal Korean women with grade 1 hypertension: a randomized, placebo-controlled trial

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Byung-Koo Yoon ◽  
Jidong Sung ◽  
Yun-Mi Song ◽  
Soo-Min Kim ◽  
Kyung-A Son ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Stiffness ◽  
Augmentation Index ◽  
Controlled Trial ◽  
Linear Regression Analysis ◽  
Estrogen Therapy ◽  
Korean Women ◽  
Research Information ◽  
Significant Difference ◽  
The Relationship

Abstract Background Estrogen therapy in early menopausal women decreases the risk of coronary heart disease and parenteral, but not oral, estrogen is reported to reduce blood pressure (BP). Progestogens are typically added to estrogens to prevent unopposed endometrial stimulation. The effects of progestogen on BP have been less well studied to date. This study was conducted to explore the impacts of micronized progesterone (MP4) combined with percutaneous estradiol gel (PEG) on hemodynamics in postmenopausal Korean women with grade 1 hypertension. Methods Fifty-two postmenopausal women (aged 49–75 years) with systolic BP (SBP) of 140–160 mmHg or diastolic BP (DBP) of 90–100 mmHg were randomly assigned for 12 weeks to placebo (n = 16), estrogen therapy (ET) (n = 19) with PEG (0.1 %, 1 g./d), or estrogen + progestogen therapy (EPT, n = 17) with PEG and MP4 (100 mg/d). The primary endpoint was ambulatory BP and the secondary endpoints were arterial stiffness as brachial–ankle pulse-wave velocity (baPWV) and aortic parameters on applanation tonometry. Results One woman in the ET group dropped out, so 51 participants were finally analyzed. Outcome measures for ambulatory BP and arterial stiffness were not different between groups. Within-group comparisons showed that EPT significantly decreased daytime heart rate and baPWV: the changes from baseline (mean ± standard deviation) were − 2.5 ± 5.7 bpm (P = 0.03) and − 0.6 ± 1.4 m/s (P = 0.04), respectively. After adjusting for baseline, linear regression analysis revealed a significant difference in the relationship between baseline and 12-week baPWV among groups (P = 0.02). The relationship was significantly different between placebo and ET (P = 0.03) and EPT (P = 0.01), respectively, but not between ET and EPT. Additionally, pooled results of active treatments disclosed that SBP, DBP, PWV, and augmentation index at the aorta were significantly reduced relative to baseline. Conclusions There was no difference in ambulatory BP between ET and EPT in postmenopausal Korean women with grade 1 hypertension. Further, ET and EPT similarly decreased baPWV from baseline as compared with placebo. MP4 might not adversely influence estrogen effects on ambulatory BP and arterial stiffness. Trial registration Clinical Research Information Registry, KCT0005405, Registered 22 September 2020 - Retrospectively registered, https://cris.nih.go.kr/cris/search/detailSearch.do?all_type=Y&search_page=L&pageSize=10&page=1&seq=17608&search_lang=E.

scholarly journals Endothelial dysfunction and impaired arterial wall properties in patients with retinal vein occlusion

2020 ◽  
Vol 25 (4) ◽  
pp. 302-308
Author(s):  
Nikolaos Gouliopoulos ◽  
Gerasimos Siasos ◽  
Marilita M Moschos ◽  
Evangelos Oikonomou ◽  
Alexandros Rouvas ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Endothelial Dysfunction ◽  
Arterial Stiffness ◽  
Endothelial Function ◽  
Retinal Vein Occlusion ◽  
Augmentation Index ◽  
Vascular Lesion ◽  
Reflected Waves ◽  
Vein Occlusion ◽  
Increased Risk

Retinal vein occlusion (RVO) is a common retinal vascular lesion, and a leading cause of visual impairment. Patients with RVO have an increased risk for cardiovascular disease and share multiple common risk factors. In this study, we investigated the endothelial function and arterial stiffness of patients with RVO compared to healthy-control (CL) subjects. We enrolled 40 consecutive patients with RVO and 40 CL subjects. RVO was diagnosed by an ophthalmologist, endothelial function was evaluated by flow mediated dilation (FMD) in the brachial artery, and carotid-femoral pulse wave velocity (PWV) and augmentation index (AIx) of the radial artery were measured to evaluate arterial stiffness and reflected waves, respectively. No significant differences were detected between the studied groups in sex, age, presence of hypertension or dyslipidemia, body mass index, systolic and diastolic blood pressure levels, total cholesterol levels, and smoking habits ( p > 0.05 for all). However, patients with RVO had impaired FMD ( p = 0.002) and increased PWV ( p = 0.004), even after adjustment for several confounders. Both FMD and PWV were also significantly and independently associated with the development of RVO. Furthermore, a significant and positive correlation between PWV and systolic blood pressure existed only in the CL group. Therefore, we have shown that RVO is associated with significant endothelial dysfunction and increased arterial stiffness. Our results strengthen the vascular theory, according to which, systemic endothelial dysfunction and arteriosclerosis play a significant role in the pathogenesis of RVO.

scholarly journals Augmentation Index Is Inversely Associated with Skeletal Muscle Mass, Muscle Strength, and Anaerobic Power in Young Male Adults: A Preliminary Study

2021 ◽  
Vol 11 (7) ◽  
pp. 3146
Author(s):  
Dongmin Lee ◽  
Kyengho Byun ◽  
Moon-Hyon Hwang ◽  
Sewon Lee
Keyword(s):  
Skeletal Muscle ◽  
Muscle Strength ◽  
Arterial Stiffness ◽  
Muscle Mass ◽  
Muscular Strength ◽  
Skeletal Muscle Mass ◽  
Augmentation Index ◽  
Anaerobic Power ◽  
Negatively Associated ◽  
Increased Risk

Arterial stiffness is associated with an increased risk of cardiovascular disease. Previous studies have shown that there is a negative correlation between arterial stiffness and variables such as skeletal muscle mass, muscular strength, and anaerobic power in older individuals. However, little research has been undertaken on relationships in healthy young adults. This study presents a preliminary research that investigates the association between arterial stiffness and muscular factors in healthy male college students. Twenty-three healthy young males (23.9 ± 0.5 years) participated in the study. The participants visited the laboratory, and variables including body composition, blood pressure, arterial stiffness, blood parameters, grip strength, and anaerobic power were measured. Measurements of augmentation index (AIx) and brachial-ankle pulse wave velocity (baPWV) were performed to determine arterial stiffness. There were significant positive correlations among skeletal muscle mass, muscle strength, and anaerobic power in healthy young adult males. AIx was negatively associated with a skeletal muscle mass (r = −0.785, p < 0.01), muscular strength (r = −0.500, p < 0.05), and anaerobic power (r = −0.469, p < 0.05), respectively. Likewise, AIx@75 corrected with a heart rate of 75 was negatively associated with skeletal muscle mass (r = −0.738, p < 0.01), muscular strength (r = −0.461, p < 0.05), and anaerobic power (r = −0.420, p < 0.05) respectively. However, the baPWV showed no correlation with all muscular factors. Our findings suggest that maintaining high levels of skeletal muscle mass, muscular strength, and anaerobic power from relatively young age may lower AIx.

scholarly journals The Copenhagen chronic kidney disease echo study (COInCYDE)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Landler ◽  
S Bro ◽  
B Feldt-Rasmussen ◽  
D Hansen ◽  
A.L Kamper ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Cardiac Function ◽  
Left Ventricular ◽  
Funding Source ◽  
Ckd Stage ◽  
Significant Difference ◽  
Stage 1

Abstract Background The cardiovascular mortality of patients with chronic kidney disease (CKD) is 2–10 times higher than in the average population. Purpose To estimate the prevalence of abnormal cardiac function or structure across the stages CKD 1 to 5nonD. Method Prospective cohort study. Patients with CKD stage 1 to 5 not on dialysis, aged 30 to 75 (n=875) and age-/sex-matched controls (n=173) were enrolled consecutively. All participants underwent a health questionnaire, ECG, morphometric and blood pressure measurements. Blood and urine were analyzed. Echocardiography was performed. Left ventricle (LV) hypertrophy, dilatation, diastolic and systolic dysfunction were defined according to current ESC guidelines. Results 63% of participants were men. Mean age was 58 years (SD 12.6 years). Mean eGFR was 46.7 mL/min/1,73 m (SD 25.8) for patients and 82.3 mL/min/1,73 m (SD 13.4) for controls. The prevalence of elevated blood pressure at physical exam was 89% in patients vs. 53% in controls. Patients were more often smokers and obese. Left ventricular mass index (LVMI) was slightly, albeit insignificantly elevated at CKD stages 1 & 2 vs. in kontrols: 3.1 g/m2, CI: −0.4 to 6.75, p-value 0.08. There was no significant difference in LV-dilatation between patients and controls. Decreasing diastolic and systolic function was observed at CKD stage 3a and later: LVEF decreased 0.95% (CI: −1.5 to −0.2), GLS increased 0.5 (CI: 0.3 to 0.8), and OR for diastolic dysfunction increased 3.2 (CI 1.4 to 7.3) pr. increment CKD stage group. Conclusion In accordance to previous studies, we observe in the CPHCKD cohort study signs of early increase of LVMI in patients with CKD stage 1 & 2. Significant decline in systolic and diastolic cardiac function is apparent already at stage 3 CKD. Figure 1. Estimated GFR vs. GLS & histogram of GLS Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): The Capital Region of Denmark

scholarly journals P0828CKD STAGE DISTRIBUTION IN AN ITALIAN PROVINCE; SEVEN YEARS OF FOLLOW UP

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Alessandro Roggeri ◽  
Daniela Paola Roggeri ◽  
Carlotta Rossi ◽  
Marco Gambera ◽  
Rossana Piccinelli ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Administrative Database ◽  
Ca Channel ◽  
Dialysis Treatment ◽  
First Choice ◽  
Stage 4 ◽  
Ckd Stage ◽  
Significant Difference ◽  
Stage 1

Abstract Background and Aims Chronic kidney disease (CKD) is a chronic illness with important implications for the health of the population and for the commitment of resources by public health services. CKD staging makes it possible to assess the severity of the disease and its distribution in the population. The distribution of the stages of CKD diagnosed through hospitalization were analyzed using administrative database of the Local Health Authority of a province with a population of about 1 million inhabitants in northern Italy. Method Patients with hospital discharge with a diagnosis of CKD (ICD9CM 5851, 5852, 5853, 5854) in 2011- 2012 years, without dialysis treatment, neither transplantation procedure nor acute renal failure were selected. Demographic characteristics, comorbidities, dialysis treatment, drugs prescription and nephrological follow-up were investigated. This cohort of patients was examined over a 7-year period (2011-2017). Stage five was not considered to avoid possible misunderstanding with five D stage. Results 1808 patients diagnosed with CKD were extracted from the 2011-2017 administrative database; of these, 1267 had a diagnosis with the CKD stage specification. The distribution of 1267 patients in the CKD stages at the first hospital discharge was as follows: 7.4% stage 1, 30.9% stage 2, 42.3% stage 3, 19.3% stage 4. The 832 patients described in the study were still alive as of Jan. 1, 2013 while 435 (34.3%) died by Dec. 31, 2012. Until Dec. 31, 2017, 503 of the 832 patients died representing the 52.8% of stage 1 patients, 62% of stage 2 patients, 58.2% of stage 3 patients, 66.4% of stage 4 patients. Males were the most prevalent gender (58.5%), without any significant difference into CKD stages. Our patients have a fairly high age as can be seen from the table 1. The presence of co-morbidities was assessed either directly for the main risk factors or by the modified Charlson index (MCI) for CKD patients. The average value of the MCI is 3.8 ± 3.1 for all patients and 3.4 ±3.0 for stage 1, 4.1 ± 3.3 for stage 2, 3.7 ± 3.1 for stage 3, 3.7 ± 2.9 for stage 4, with maximum values of 12.0, 17.0, 16.0 and 14.0 respectively. About 40% of patients had diabetes mellitus, with the highest prevalence in stage 4 (49.3%) and the lowest in stage 1 (25%). Cardiovascular disease was distributed almost equally among all patients with a value between 82% in stage 1 and 86.3% in stage 4. Cancer were present in 26.3% of patients with similar values in all stages. Just about 9% of patients underwent dialysis treatment for achieving ESRD, with a percentage of 5.6% among patients in stage 1 and 17.1% among those in stage 4. Hemodialysis represented first choice treatment (86%) compared with peritoneal one (14%). Time from the diagnosis of CKD to the first dialysis was variable with an average of 3.4 ±1.7 years; the longest interval for patients in stage 1 (5.1±1.8) and the shortest (3.0 ±1.6) for patients in stage 4. The number of nephrological visits at renal units was analyzed for an assessment of the extent of follow-up and prevention upon reaching the ESRD (table2). More than 90% of patients had prescribed drugs antagonists of the renin angiotensin system, in all stages of CKD; other antihypertensive drugs (Ca channel blockers and peripheral vasodilators) had a similar prescription level. Anemia control drugs (ESA and iron) had an incremental prescription with stages of the disease from 51.4% in stage 1 to 74% in stage 4, similarly to Ca-P metabolism control drugs ranging from 44.4% in stage 1 to 67.8% in stage 4. Conclusion Correct staging of CKD is very important to assess the prognosis of patients, but the major determinants of outcome are comorbidities and age of the patients. The cohort examined has a high mortality rate, far higher than reported in the literature for CKD. It should be noted that the sample was identified by hospitalization for cardiovascular diseases more than 50% complicated by diabetes and hypertension, so death represents the main outcome and not ESRD.

MO570PULSE PRESSURE: A PREDICTOR OF CARDIOVASCULAR CALCIFICATION AND CARDIOVASCULAR MORTALITY IN HEMODIALYSIS PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Merita Rroji (Molla) ◽  
Saimir Seferi ◽  
Majlinda Cafka ◽  
Erjola Likaj ◽  
Vilma Cadri ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Stiffness ◽  
Abdominal Aorta ◽  
Cardiovascular Mortality ◽  
Pulse Pressure ◽  
Univariate Analysis ◽  
Hemodialysis Patients ◽  
Case Series Study ◽  
Increased Risk ◽  
Elevated Systolic Blood Pressure

Abstract Background and Aims The mortality rate is extremely high in chronic kidney disease (CKD), primarily due to the high prevalence of cardiovascular disease (CVD). Increased pulse pressure (PP), defined as the difference between inappropriately elevated systolic blood pressure (SBP) and reduced diastolic blood pressure (DBP) at any value of mean arterial pressure (MAP), is a surrogate measure of increased arterial stiffness of central elastic arteries (aorta and its major branches). CKD-MBD anomalies leading to calcification contribute to increased arterial stiffness and pulse pressure. This study aimed to evaluate the relationship of pulse pressure parameter with valve calcification and abdominal aortic calcification in hemodialysis patients and its impact on cardiovascular mortality. Method We performed a prospective case series study with 3 years follow- up. Plain X-ray images of the lateral lumbar spine from all subjects were studied to obtain images of the lower abdominal aorta using semiquantitative scores as described by Kauppila et al. Cardiac valve calcifications were evaluated by two-dimensional echocardiography with an HDI 5000 Sono CT echocardiographic machine with a 3.3-MHz multiphase array probe in subjects lying in the left decubitus position an according to the recommendations of the European Association of Echocardiography. The patient was evaluated as having vascular calcification if he had the presence of calcification in at least one of the site examined: a mitral valve, aortic valve or abdominal aorta. Results We studied 85 chronic stable hemodialysis patients. Mean age and meantime is therapy was 49.9±12.4 years and 51.5±28.7 months, respectively. Mean pulse pressure was 55.72±14.2 mmHg. Fifty-nine patients (69.4%) were identified with aortic abdominal calcification, and the mean Kauppila score was 4.91 ± 4.05. Sixty patients (70.5%) had at least one valve calcified, while thirty-three patients (38.8%) had both valves calcified. Univariate analysis revealed that every 1 mmHg increase in pulse pressure was associated with increased cardiovascular calcification risk p=0.020. In multivariate analysis, after adjustment for age, gender, diabetes mellitus, cholesterol, and triglyceride serum levels, the association also remained strong, where every increase of 1 mm Hg in pulse pressure was associated with increased risk for cardiovascular calcification (HR 1.02, 95% CI (1.00-1.03), p= 0.038). Besides, pulse pressure was an independent predictor for cardiovascular mortality (HR 1.03, 95% CI (1.02-1.05), p=0.002). Conclusion Pulse pressure may identify hemodialysis patients with subclinical cardiovascular calcification who need further evaluation. Wide pulse pressure is associated with increased cardiovascular mortality.

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