scholarly journals Aortic Pulse Wave Velocity in Peritoneal Dialysis Patients Is Not Simply Associated with Extracellular Water Expansion

2019 ◽  
Vol 44 (6) ◽  
pp. 1423-1431 ◽  
Author(s):  
Kamonwan Tangvoraphonkchai ◽  
Andrew Davenport
Keyword(s):  
Peritoneal Dialysis ◽  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Pulse Wave ◽  
Aortic Pulse Wave Velocity ◽  
Extracellular Water ◽  
Peritoneal Membrane ◽  
Β Blocker ◽  
Independent Association ◽  
Total Body

Background: Cardiac death is increased in peritoneal dialysis (PD) patients. Pulse wave velocity (PWV) is a measurement of arterial stiffness, and previous reports linked PWV to increased extracellular water (ECW). As cyclers and icodextrin are increasingly used, we wished to determine whether this association between PWV and ECW remains. Methods: We measured aortic PWV (aPWV) and bioimpedance (InBody, Seoul, South Korea) in consecutive PD patients attending for peritoneal membrane testing. Results: 189 patients were included, 62.4% male, mean age 63.1 ± 15.2 years, 45.3% diabetic, median dialysis duration 12.3 (6.5–25.1) months, 71.4% using cyclers, weight 73.0 ± 16.1 kg, systolic blood pressure 142 ± 21 mm Hg, aPWV 10.4 ± 5.1 m/s. aPWV was associated with pulse pressure (r = 0.26, p = 0.001), Davies comorbidity score (r = 0.18, p = 0.013), and N-terminal pro-brain-type natriuretic peptide (NTproBNP; r = 0.18, p = 0.011). Patients with aPWV ≥10 m/s were older (65.9 ± 13.6 vs. 60.1 ± 16.3 years, p < 0.01) with a higher ECW-to-total body water ratio (0.400 ± 0.012 vs. 0.396 ± 0.013, p < 0.05), but ECW/height was not different (8.52 ± 2.32 vs. 8.75 ± 1.78 L/m), as was NTproBNP (2,472 [788–5,422] vs. 1,234 [410–6,230] ng/L). On multivariable testing, aPWV was positively associated with β-blocker prescription (standardised β coefficient [Stβ] 0.3, 95% confidence limits [95% CL] 0.7–2.6, p = 0.001) and negatively with icodextrin prescription (Stβ 0.19, 95% CL –0.2 to –2.1, p = 0.04). Conclusions: Compared to previous studies, we did not find an independent association between aPWV and ECW and estimates of ECW excess, using the InBody bioimpedance device, suggesting that vascular stiffness in PD patients is more complex than simple ECW volume expansion in PD patients.

Changes in aortic pulse wave velocity in peritoneal dialysis do not mirror changes in extracellular water measured by bioimpedance

2020 ◽  
pp. 039139882093110
Author(s):  
Kamonwan Tangvoraphonkchai ◽  
Andrew Davenport
Keyword(s):  
Peritoneal Dialysis ◽  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Pulse Wave ◽  
Aortic Pulse Wave Velocity ◽  
Confidence Limits ◽  
Extracellular Water ◽  
C Reactive Protein ◽  
Dialysis Patients ◽  
Reactive Protein

Background: 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. Methods: We repeated aortic pulse wave velocity and bioimpedance-derived extracellular water measurements in peritoneal dialysis patients attending for assessment of peritoneal membrane function. Results: 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. Conclusion: 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.

Does Pulse Wave Velocity Increase Over Time in Hemodialysis Patients?

2020 ◽  
pp. 1-6
Author(s):  
Theerasak Tangwonglert ◽  
Andrew Davenport
Keyword(s):  
Blood Pressure ◽  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Pulse Wave ◽  
Pressure Control ◽  
Extracellular Water ◽  
Velocity Increase ◽  
Multifrequency Bioimpedance ◽  
Total Body ◽  
Over Time

<b><i>Objectives:</i></b> Arterial stiffness, measured by pulse wave velocity (PWV), is reported to be increased in hemodialysis (HD) patients and increases cardiovascular mortality. Previous studies have reported an association between extracellular water (ECW) and PWV. We wished to review whether PWV increases over time and whether this is associated with ECW. <b><i>Methods:</i></b> We reviewed repeat aortic PWV measurements using an oscillograph method along with corresponding ECW measured by multifrequency bioimpedance in HD patients a minimum of 5 years apart. <b><i>Results:</i></b> Twenty-four patients (16 [66.7%] male and 11 [45.8%] diabetic, mean age 61.7 ± 15.2 years) had PWV and ECW initially measured after 46 (26–124) months of HD and then after 112 (97–202) months. Overall, there was no change in PWV or ECW (9.4 ± 2.2 vs. 8.1 ± 2.5 cm/s; 14.7 ± 2.5 vs. 15.2 ± 2.9 L, respectively), whereas the ECW/total body water ratio increased (0.399 ± 0.015 vs. 0.408 ± 0.021, <i>p</i> &#x3c; 0.05). We found no association between changes in PWV and ECW (<i>r</i> = −0.05, <i>p</i> = 0.84), whereas there was an association with the change in peri-dialytic systolic blood pressure (SBP) (<i>r</i> = 0.59, <i>p</i> = 0.007). <b><i>Conclusion:</i></b> In our small observational study, there was no overall change in PWV, after 5 years of HD, with PWV increasing in 50% and falling in 50%. Changes in PWV were not associated with changes in ECW but were associated with changes in peri-dialytic SBP. Our study demonstrates that PWV does not increase in all HD patients with time, and interventional studies are required to determine whether targeted blood pressure control reduces PWV in HD patients.

An Association between Aortic Pulse Wave Velocity, Blood Pressure and Chronic Inflammation in ESRD Patients on Peritoneal Dialysis

2003 ◽  
Vol 26 (3) ◽  
pp. 188-195 ◽  
Author(s):  
T. Stompór ◽  
M. Rajzer ◽  
W. Sułowicz ◽  
A. Dembińska-Kieć ◽  
K. Janda ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Inflammatory Process ◽  
Pulse Wave ◽  
Aortic Pulse Wave Velocity ◽  
Study Population ◽  
Aortic Stiffening ◽  
Esrd Patients

Increased aortic pulse wave velocity (AoPWV) has been identified as a risk factor for cardiovascular morbidity in the general population and in patients on dialysis. Most of the studies in ESRD patients refer to subjects on hemodialysis. Influence of the inflammatory process on aortic stiffening remains largely unknown. The aim of the present study was to evaluate potential relationships between AoPWV and blood pressure, basic anthropometric parameters, selected growth factors and markers of the inflammatory process in ESRD patients treated with peritoneal dialysis. The study population consisted of 43 patients (19 F, 24 M) with a mean age of 50.6 ±13.4 years on PD for a mean period of 21.9 ± 20.7 months. AoPWV was measured using two pressure transducers placed on the carotid and femoral arteries and connected to an automatic processor (Complior® Colson AS, Paris, France). Serum levels of Tumor Necrosis Factor alpha (TNFα), interleukin 6 (IL-6) and plasma basic Fibroblast Growth Factor (bFGF) were measured with ELISA; C-reactive protein and fibrinogen with nephelometry. Serum lipid profile was also assessed. Blood pressure was measured in an outpatient department under standardized conditions. Mean aortic pulse wave velocity in the study population was 10.7 ±2.1 m/s. No difference in AoPWV was found between men and women. AoPWV correlated significantly with age (R=0.41; p <0.01) but not with time on dialysis. Positive relationship between AoPWV and body weight and BMI was shown (R = 0.31; p < 0.05 and R = 0.35; p < 0.05, respectively). AoPWV correlated significantly with systolic blood pressure (SBP), mean arterial pressure (MAP) and pulse pressure (PP) (R = 0.46, p < 0.005, R = 0.46, p < 0.005 and R = 0.43, p < 0.01, respectively). AoPWV correlated with serum IL-6 and plasma bFGF (R = 0.32, p < 0.05 and R 0.4, p < 0.01; respectively). The correlation with serum CRP was borderline significant (p < 0.53). In multiple regression analysis age (beta 0.38; p < 0.005), plasma bFGF level (beta 0.3; p < 0.05), and systolic blood pressure (beta 0.29; p < 0.05) were independently associated with pulse wave velocity. Our results suggest that AoPWV values in patients on PD are associated with factors similar to those encountered in the general population. We suggest that increased aortic stiffening may also be related to the chronic inflammatory process in PD patients.

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