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Pulse Wave Velocity and Augmentation Index in ESRD Patients on Maintenance Hemodialysis

Aim: Patients with end-stage renal disease (ESRD) are at increased risk of cardiovascular disease and it has been shown that increased conduit artery stiffness is a major contributing factor. Pulse wave velocity (PWV) and augmentation index (AIx) are parameters of arterial stiffness and wave reflection and are used increasingly in clinical practice as potent indicators of cardiovascular risk. Both, PWV and AIx can be assessed noninvasively using various methods. Arterial stiffness is associated with increased systolic blood pressure (SBP) and decreased diastolic blood pressure (DBP). Blood pressure falls during dialysis because of ultrafiltration, and then rises gradually before the next session mainly due to water retention. Therefore, post-dialysis blood pressure may give a better estimate of hypertension. Patients and methods: To identify the impact of blood pressure on PWV and AIx in hemodialysis patients, we conducted a pilot study on a cohort of 30 patients. All measurements were performed with TensioMedTM Arteriograph that uses a relatively new method to determine PWV and AIx, by analysis of the oscillometric pressure curves registered on the upper arm. The principle of this method is based on plethysmography and registers pulsatile pressure changes in an artery. The device initially measures the blood pressure in the upper arm oscillometrically and afterwards produces a cuff pressure over the brachial artery that is 35mmHg in excess of the systolic blood pressure measured. The pressure fluctuations in the brachial artery are now detected by the cuff. They are passed on to the computer, recorded and analyzed by specific software. The measurements were performed on brachial artery from the non-fistula arm. Data on SBP, DBP, PWV and Aix were collected before and 15 minutes after dialysis. We divided patients in a two groups based on whether they were normotensive or hypertensive before dialysis. Results: There were no statistically significant differences in pre-dialysis PWV and AIx between these two groups. Furthermore, despite of significantly decreased post-dialysis SBP in both groups, the value of PWV and AIx remained unchanged. Conclusion: Although PWV and AIx should improve with blood pressure, their values in hemodialysis patients are independent of blood pressure reduction and are better cardiovascular risk predictor.

Pulse Wave Velocity; Hypertension; Hemodialysis

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