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Assessment of Vascular Function in Patients With Chronic Kidney Disease

Assessment of Vascular Function in Patients With Chronic Kidney Disease

Published on: June 16, 2014

Noninvasive indices of arterial stiffness in hemodialysis patients

Kiyo Ueyama¹, Masaaki Miyata, Takuro Kubozono

¹Department of Cardiovascular, Respiratory and Metabolic Medicine, Graduate School of Medicine, Kagoshima University, Kagoshima 890-8520, Japan.

Hypertension Research : Official Journal of the Japanese Society of Hypertension

|June 13, 2009

Insights

Brachial-ankle pulse wave velocity (baPWV) and cardio-ankle vascular index (CAVI) effectively measure arterial stiffness in hemodialysis patients. These indices, higher in hemodialysis patients, correlate with age and blood pressure, aiding clinical assessment.

Area of Science:

Cardiovascular Medicine
Nephrology
Biomedical Engineering

Background:

Arterial stiffness is a significant predictor of cardiovascular events.
Hemodialysis patients exhibit accelerated vascular aging and increased arterial stiffness.
Non-invasive measures of arterial stiffness are crucial for risk stratification in hemodialysis patients.

Purpose of the Study:

To evaluate the diagnostic validity of brachial-ankle pulse wave velocity (baPWV) and cardio-ankle vascular index (CAVI) for assessing arterial stiffness in hemodialysis (HD) patients.
To compare baPWV and CAVI measurements in HD patients versus healthy controls.
To investigate the correlation of baPWV and CAVI with clinical parameters and carotid intima-media thickness (IMT) in HD patients.

Main Methods:

A cohort of 160 hemodialysis patients and age/gender-matched healthy controls were enrolled.
Brachial-ankle pulse wave velocity (baPWV) and cardio-ankle vascular index (CAVI) were measured using VaSera VS-1000.
Carotid artery maximum intima-media thickness (max IMT) was assessed via ultrasonography; blood parameters were also analyzed.

Main Results:

Both baPWV and CAVI were significantly elevated in HD patients compared to controls (P<0.0001 for baPWV, P<0.01 for CAVI).
baPWV and CAVI demonstrated significant positive correlations with age, systolic blood pressure, pulse pressure, Kt/V, Brinkman index, and max IMT.
Multiple regression analysis confirmed independent correlations of baPWV and CAVI with age and systolic blood pressure; ROC analysis showed similar predictive power for increased max IMT.

Conclusions:

Brachial-ankle pulse wave velocity (baPWV) and cardio-ankle vascular index (CAVI) are valid and useful non-invasive indices for assessing arterial stiffness in hemodialysis patients.
These measures reflect key pathophysiological changes in the vasculature of HD patients.
CAVI was observed to be influenced by fluid volume changes during hemodialysis sessions.

Read full analysis

Abstract:

The purpose of this study was to evaluate the validity of brachial-ankle pulse wave velocity (baPWV) and the cardio-ankle vascular index (CAVI) as measures of arterial stiffness in hemodialysis (HD) patients. We studied 160 consecutively enrolled HD patients (mean age: 59+/-13 years; 91 male patients). We measured baPWV and CAVI using a VaSera VS-1000, maximum intima-media thickness (max IMT) of the carotid artery by ultrasonography and blood renal and lipid parameters. As a control, baPWV and CAVI were also measured in age- and gender-matched healthy volunteers. Both baPWV and CAVI were significantly higher in HD patients than in controls (baPWV: 1698+/-355 vs. 1454+/-263 cm s(-1), P<0.0001; CAVI: 9.3+/-1.4 vs. 8.9+/-1.2, P<0.01). BaPWV correlated positively with age (r=0.549, P<0.0001), systolic blood pressure (SBP) (r=0.510, P<0.0001), diastolic blood pressure (r=0.203, P<0.0001), pulse pressure (PP) (r=0.499, P<0.0001), Kt V(-1) (r=0.221, P<0.01), Brinkman index (r=0.186, P<0.05) and max IMT (r=0.285, P<0.001). CAVI also correlated positively with age (r=0.562, P<0.0001), SBP (r=0.395, P<0.0001), PP (r=0.490, P<0.0001), Kt V(-1) (r=0.216, P<0.01), Brinkman index (r=0.238, P<0.01) and max IMT (r=0.280, P<0.001). Multiple regression analysis demonstrated baPWV and CAVI correlated independently with age and SBP. Receiver operating characteristics (ROC) curve analysis demonstrated that baPWV and CAVI had similar power to predict increases in max IMT. We also measured baPWV and CAVI immediately before and after HD, and showed CAVI was influenced by changes in water volume. Both baPWV and CAVI are therefore useful indices of arterial stiffness in HD patients.

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