Variability of pulse wave velocity and mortality in chronic hemodialysis patients

Area of Science:

• Nephrology
• Cardiovascular Physiology
• Medical Statistics

Background:

• Chronic hemodialysis (HD) patients exhibit cyclic variations in hydration and blood pressure, affecting pulse wave velocity (PWV).
• Previous research established a link between hydration status, blood pressure, and PWV fluctuations in HD patients.

Purpose of the Study:

• To investigate whether the cyclic variation of pulse wave velocity (PWV) influences mortality in patients undergoing chronic hemodialysis.
• To determine if changes in PWV before and after dialysis sessions correlate with patient survival outcomes.

Main Methods:

• Studied 167 oligoanuric patients on chronic standard bicarbonate HD for at least 6 months.
• Classified patients into three groups based on PWV: normal pre- and post-dialysis (LL), high pre- and normal post-dialysis (HL), and high pre- and post-dialysis (HH).
• Measured carotid-femoral PWV using an automated foot-to-foot method and analyzed all-cause and cardiovascular mortality over a 2-year follow-up.

Main Results:

• The HH group (41.9% of patients) showed a significantly higher prevalence of established atherosclerotic cardiovascular disease (ASCVD).
• Mortality rates were highest in the HH group (50.7%), followed by the HL group (30.2%), and lowest in the LL group (11.4%).
• Significant differences in mortality were observed between all groups (LL vs. HL, P=0.047; LL vs. HH, P<0.00001; HL vs. HH, P=0.034).

Conclusions:

• This study provides the first evidence that different patterns of PWV behavior in dialysis patients are associated with varying mortality risks.
• Consistently high PWV before and after hemodialysis is a significant predictor of increased all-cause and cardiovascular mortality.
• The findings highlight the importance of monitoring PWV dynamics in HD patients for risk stratification and potentially improving patient outcomes.