Disparate Information Provided by Pulse Wave Velocity versus Other Measures of Aortic Compliance in End-Stage Renal Disease

Introduction: Unfavorable changes in cardiac and arterial function are related to poor prognosis in chronic kidney disease (CKD). We compared hemodynamic profiles between subjects with end-stage renal disease and 2 control groups with corresponding pulse wave velocities (PWVs). Methods: Noninvasive hemodynamics were recorded during passive head-up tilt in CKD stage 5 patients (n = 35), patients with primary hypertension (n = 35, n = 30 with antihypertensive medications), and subjects without cardiovascular or renal diseases and cardiovascular medications (n = 70). The groups were selected to have corresponding age, sex, body mass index, and PWV. Hemodynamic data were captured using whole-body impedance cardiography and radial tonometric pulse wave analysis. Results: Supine blood pressure did not differ between the groups, but upright diastolic blood pressure was lower in CKD patients than in the 2 control groups (p ≤ 0.001 for both, RANOVA). Despite similar PWV, supine aortic pulse pressure was higher in CKD patients versus nonmedicated subjects (p = 0.029). Two additional measures indicated reduced aortic compliance in CKD patients versus both control groups: lower ratio of stroke index to aortic pulse pressure (p ≤ 0.023) and higher aortic characteristic impedance (p ≤ 0.003). The subendocardial viability ratio was lower in the CKD group than in both control groups (p ≤ 0.039). Conclusion: In the absence of differences in PWV, higher aortic pulse pressure and characteristic impedance, and lower ratio of stroke index to aortic pulse pressure, suggest reduced aortic compliance and impaired left ventricular function in CKD patients. A lower subendocardial viability ratio predisposes the CKD patients to impaired cardiac oxygen supply versus hypertensive patients and nonmedicated controls.

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Contribution of Volume Overload and Angiotensin II to the Increased Pulse Wave Velocity of Hemodialysis Patients

Journal of the American Society of Nephrology ◽

10.1681/asn.v131177 ◽

2002 ◽

Vol 13 (1) ◽

pp. 177-183

Author(s):

J. L. Tycho Vuurmans ◽

Walther H. Boer ◽

Willem-Jan W. Bos ◽

Peter J. Blankestijn ◽

Hein A. Koomans

Keyword(s):

Angiotensin Ii ◽

Healthy Subjects ◽

Pulse Wave ◽

Volume Overload ◽

Hemodialysis Patients ◽

Volume Reduction ◽

Aortic Compliance ◽

Dialysis Patients ◽

Stage Renal Disease ◽

End Stage

ABSTRACT. Aortic compliance is decreased in patients with end-stage renal disease. This malfunction contributes to high aortic systolic pressures and thus to the development of left ventricular hypertrophy. It was hypothesized that besides structural vascular changes, functional changes as a result of hypervolemia and increased vasoconstrictor activity, in particular angiotensin II, play a role in decreasing aortic compliance. Nineteen hemodialysis patients were studied before and 24 h after they had been dialyzed to dry weight. Applanation tonometry of peripheral arteries was used to estimate aortic pulse wave velocity (PWV), known to depend on aortic compliance, and aortic systolic pressure augmentation (augmentation index [Aix]). Predialysis aortic PWV was increased in the dialysis patients compared with matched healthy subjects (9.9 ± 3.1 versus 7.5 ± 1.1 m/s; P < 0.05). The AIx was also increased (35 ± 6 versus 25 ± 10; P < 0.05). Volume reduction with dialysis had no significant effect on PWV (9.3 ± 1.5 m/s), but the AIx decreased (28 ± 7; P < 0.05). A subset of 10 patients were restudied after 1 wk of angiotensin-converting enzyme inhibition (ACEi) with enalapril 5 mg once daily. ACEi decreased both predialysis as postdialysis BP but had no effect on pulse pressure and heart rate, which remained elevated compared with healthy subjects. ACEi also decreased predialysis aortic PWV, from 11.0 ± 3.5 to 9.1 ± 2.1 m/s (P < 0.05) but had no significant effect on AIx. During treatment with ACEi, the same volume reduction with dialysis decreased aortic PWV further to 8.0 ± 1.4 m/s (P < 0.05), a figure not different from PWV in healthy subjects. AIx decreased to an even slightly subnormal value (12 ± 23; P < 0.05). It was concluded that volume overload and angiotensin II both contribute to elevated PWV and AIx in dialysis patients. Volume reduction and ACEi both improve the aortic PWV and AIx. Combined volume reduction and ACEi has an enhanced effect that, in the present patients, was so large that PWV and AIx were no longer elevated. Monitoring and correcting of arterial pressure waves is feasible and may be an important tool in the treatment of patients with end-stage renal disease.

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M.555 Assessing pulse wave velocity and biophysical properties of the aorta in patients with end-stage renal disease

Atherosclerosis ◽

10.1016/s0021-9150(04)90553-9 ◽

2004 ◽

Vol 5 (1) ◽

pp. 128-129

Author(s):

D KARAKITSOS

Keyword(s):

Pulse Wave Velocity ◽

Renal Disease ◽

Wave Velocity ◽

End Stage Renal Disease ◽

Pulse Wave ◽

Biophysical Properties ◽

Stage Renal Disease ◽

End Stage

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Pulse Pressure Relationships with Demographics and Kidney Function in Ashanti, Ghana

International Journal of Hypertension ◽

10.1155/2018/7864564 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6

Author(s):

Debasish Banerjee ◽

Jacob Plange-Rhule ◽

Nihil Chitalia ◽

Kwabena Kumi ◽

Frank B. Micah ◽

...

Keyword(s):

Kidney Function ◽

Pulse Pressure ◽

Multivariate Regression Analysis ◽

West African ◽

African Population ◽

Rural Village ◽

Stage Renal Disease ◽

End Stage ◽

The Relationship ◽

The City

Introduction. Hypertension, particularly pulse pressure [PP] is a major risk factor for end-stage renal disease. However, the effect of individual components of hypertension namely PP, systolic [SBP] and diastolic blood pressure [DBP] on kidney function, in the general African population is unknown. Methods. Data were collected on 944 participants [aged 40-75 y], living in villages in the area around the city of Kumasi, Ghana, on demographics, medications, height, weight, BP and 24-hour creatinine clearance (CrCl). Results. The demographic and clinical characteristics were: age 55(11) [mean (SD)] years, females 62%, rural village-dwellers 52%, diabetes 1·5%, BMI 21(4) kg/m2, 24-hourCrCl as a measure of glomerular filtration rate (GFR) 84(23) ml/min/1.73 m2. 29% had BP >140/90 mmHg; SBP and DBP were 125/74(26/14) mmHg, PP was 51(17) mmHg. PP increased with age by 0.55(95% CI: 0.46,0.64) mmHg/year. PP was higher (53(17) v 49(15) mmHg; p < 0.001) in the semiurban participants. GFR decreased both with increasing PP [-0.19 (-0.27,-0.10 ml/min/1.73 m2/mmHg; p < 0.001] and SBP [-0.09 (-0.14,-0.03) ml/min/1.73 m2/mmHg; p < 0.001] but there was no significant relationship with DBP [-0.04 (-0.15,0.06)]. After adjusting for SBP, the relationship between GFR and PP became steeper [-0.31 (-0.50,-0.12) ml/min/1.73 m2/mmHg; p < 0.001]. Using multivariate regression analysis that included PP, age, gender, BMI, only increasing age [-0.75 (-0.88,-0.62)] and decreasing BMI [0.49 (0.16,0.81)] were associated with decreased kidney function. Conclusions. In this homogeneous West-African population, PP increased with age and had a steeper relationship with declining kidney function than SBP or DBP.

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Comparison of aortic pressures and aortic elastic properties between patients with end-stage renal disease and healthy controls

Interventional Medicine and Applied Science ◽

10.1556/1646.11.2019.09 ◽

2019 ◽

Vol 11 (2) ◽

pp. 77-83 ◽

Cited By ~ 1

Author(s):

Macit Kalçık ◽

Mucahit Yetim ◽

Tolga Doğan ◽

İbrahim Doğan ◽

Barış Eser ◽

...

Keyword(s):

Elastic Properties ◽

End Stage Renal Disease ◽

Aortic Stiffness ◽

Aortic Distensibility ◽

Ascending Aorta ◽

Stiffness Index ◽

Healthy Controls ◽

Aortic Compliance ◽

Stage Renal Disease ◽

End Stage

Background Current evidence indicates that vascular calcification plays an essential role in the development of cardiovascular diseases in end-stage renal disease (ESRD) patients. Arterial stiffness is a marker of increased cardiovascular risk in various populations. The aim of this study is to evaluate the elastic properties of ascending aorta in patients with ESRD. Methods This single-center study enrolled 96 patients (45 females, age: 57.2 ± 12.8 years) with ESRD and 96 healthy controls (52 females, age: 55.3 ± 10.1 years). Aortic pressures and aortic elastic parameters including aortic strain, aortic distensibility, aortic stiffness index, and aortic compliance were calculated using accepted formulae. Results The hemodynamic parameters including aortic pulse pressure, aortic mean pressure, aortic fractional pulse pressure, and aortic pulsatility index were significantly higher in patients with ESRD. Systolic and diastolic aortic diameters were similar between the groups. However, pulsatile aortic diameter change, aortic strain, aortic distensibility, and aortic compliance were significantly lower, whereas aortic stiffness index was significantly higher in ESRD group. Conclusions The results demonstrated that a significant difference was present in terms of aortic blood pressures between patients with ESRD and controls. In addition, the elastic properties of ascending aorta were decreased in patients with ESRD.

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Arterial Stiffness and Renal Replacement Therapy: A Controversial Topic

International Journal of Nephrology ◽

10.1155/2015/729609 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Edmundo Cabrera Fischer ◽

Yanina Zócalo ◽

Cintia Galli ◽

Sandra Wray ◽

Daniel Bia

Keyword(s):

Renal Replacement Therapy ◽

Arterial Stiffness ◽

Replacement Therapy ◽

Arterial Wall ◽

Pulse Wave ◽

Wall Stiffness ◽

Reliable Parameter ◽

Controversial Topic ◽

Stage Renal Disease ◽

End Stage

The increase of arterial stiffness has been to have a significant impact on predicting mortality in end-stage renal disease patients. Pulse wave velocity (PWV) is a noninvasive, reliable parameter of regional arterial stiffness that integrates the vascular geometry and arterial wall intrinsic elasticity and is capable of predicting cardiovascular mortality in this patient population. Nevertheless, reports on PWV in dialyzed patients are contradictory and sometimes inconsistent: some reports claim the arterial wall stiffness increases (i.e., PWV increase), others claim that it is reduced, and some even state that it augments in the aorta while it simultaneously decreases in the brachial artery pathway. The purpose of this study was to analyze the literature in which longitudinal or transversal studies were performed in hemodialysis and/or peritoneal dialysis patients, in order to characterize arterial stiffness and the responsiveness to renal replacement therapy.

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