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Updated: Oct 7, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Direct Determination rather than Oscillometric Estimation of Systolic Blood Pressure in Patients with Severe Chronic
Amir M Benmira1,2, Olivier Moranne3,4, Camelia Prelipcean5
1Vascular Medicine, Nimes University Hospital, Nimes, France.
Insights
Accurate systolic blood pressure measurement in chronic kidney disease (CKD) is vital. The systolic foot-to-apex time interval (SFATI) technique offers a more reliable method than oscillometry for CKD patients.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Biomedical Engineering
Background:
- Arterial hypertension is a significant concern in chronic kidney disease (CKD).
- Accurate systolic blood pressure (SBP) measurement is challenging in CKD patients.
- Automatic oscillometric devices may provide erroneous SBP readings in this population.
Purpose of the Study:
- To compare the accuracy of the systolic foot-to-apex time interval (SFATI) technique against standard Korotkoff sounds and oscillometry for SBP measurement in CKD patients.
- To identify factors contributing to SBP measurement errors in CKD.
- To evaluate the clinical implications of SBP measurement accuracy for treatment decisions.
Main Methods:
- A cross-sectional study involving 89 patients with stages 4, 5, and 5D CKD.
- Comparison of SBP values obtained by SFATI, Korotkoff sounds, and oscillometry.
- Investigation of age, sex, diabetes, CKD stage, and pulse pressure as potential sources of error.
Main Results:
- All three techniques demonstrated satisfactory reproducibility.
- SFATI showed high agreement with Korotkoff sounds (CCC = 0.98) with minimal bias (1.7 ± 4.6 mm Hg).
- Oscillometry exhibited greater bias (5.9 ± 9.3 mm Hg) and misclassification rates compared to SFATI, particularly in relation to SBP thresholds of 110-130 mm Hg. Higher pulse pressure was linked to increased errors.
Conclusions:
- The SFATI technique provides accurate SBP measurements in severe CKD patients.
- SFATI has the potential to standardize automated noninvasive blood pressure measurement devices.
- Physicians must be aware of oscillometry's risk of misclassification when managing antihypertensive therapy in CKD.
Introduction:
Although arterial hypertension is a major concern in patients with chronic kidney disease (CKD), obtaining accurate systolic blood pressure (SBP) measurement is challenging in this population for whom automatic oscillometric devices may yield erroneous results.
Methods:
This cross-sectional study was conducted in 89 patients with stages 4, 5, and 5D CKD, for whom we compared SBP values obtained by the recently described systolic foot-to-apex time interval (SFATI) technique which provides direct SBP determination, the standard technique (Korotkoff sounds), and oscillometry. We investigated the effects of age, sex, diabetes, CKD stage, and pulse pressure to explain measurement errors defined as biases or misclassification relative to the SBP thresholds of 110-130-mm Hg.
Results:
All 3 techniques showed satisfactory reproducibility for SBP measurement (CCC > 0.84 and >0.91, respectively, in dialyzed and nondialyzed patients). The mean ± SD from SBP as determined via Korotkoff sounds was 1.7 ± 4.6 mm Hg for SFATI (CCC = 0.98) and 5.9 ± 9.3 mm Hg for oscillometry (CCC = 0.88). Referring to the 110-130-mm Hg SBP range outside which treatment prescription or adaptation is recommended for CKD patients, SFATI underestimated SBP in 3 patients and overestimated it in 1, whereas oscillometry underestimated SBP in 12 patients and overestimated it in 3. Higher pulse pressure was the main explanatory factor for measurement and classification errors.
Discussion/Conclusion:
SFATI provides accurate SBP measurements in patients with severe CKD and paves the way for the standardization of automated noninvasive blood pressure measurement devices. Before prescribing or adjusting antihypertensive therapy, physicians should be aware of the risk of misclassification when using oscillometry.
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