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Assessment of Vascular Function in Patients With Chronic Kidney Disease

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Hemodialysis Parameters and Pulse Wave Velocity

Sanja Miseljic¹, Buena Aziri², Edin Begic^2,3

¹Clinic for Heart, Blood Vessel and Rheumatic Diseases, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.

International Journal of Applied & Basic Medical Research

|February 2, 2023

Insights

Ultrafiltration significantly reduced aortic stiffness in overhydrated hemodialysis patients, highlighting the impact of hydration status on vascular health. Monitoring brachial-ankle pulse wave velocity is crucial for these patients.

Area of Science:

Cardiovascular Physiology
Nephrology
Biomedical Engineering

Background:

Hemodialysis (HD) patients often experience fluid overload, impacting cardiovascular health.
Aortic stiffness, a predictor of cardiovascular events, is influenced by hydration status.

Purpose of the Study:

To investigate the acute effects of ultrafiltration during hemodialysis on aortic mechanical properties.
To assess the relationship between hydration status and brachial-ankle pulse wave velocity (PWV) in HD patients.

Main Methods:

Eighty long-term HD patients were studied, with hydration status assessed using multifrequency bioimpedance spectroscopy (BCM).
Brachial-ankle pulse wave velocity (PWV) and Augmentation Index (AIx) were measured using an arteriograph before and after HD.
Participants were categorized into overhydrated (n=40) and normovolemic (n=40) groups.

Main Results:

Overhydration and relative overhydration positively correlated with PWV (r=0.290, P<0.001).
Left atrial diameter also showed a significant positive correlation with PWV (r=0.359, P<0.001).
In the overhydrated group, mean PWV significantly decreased post-HD (14.32 to 8.72 m/s, P=0.0001), while the normovolemic group showed no significant change (13.39 to 10.39 m/s).
Univariate regression analysis indicated overhydration as the sole factor affecting PWV before and after HD.

Conclusions:

Overhydration significantly impacts brachial-ankle PWV in hemodialysis patients.
Ultrafiltration effectively reduces aortic stiffness in overhydrated individuals.
Regular monitoring of brachial-ankle PWV is recommended for hemodialysis patients to manage vascular health.

Read full analysis

Abstract

Aim:

The study aimed to evaluate the acute effect of ultrafiltration on the mechanical properties of the aorta using brachial-ankle pulse wave velocity (PWV) before and after hemodialysis (HD).

Patients And Methods:

This study included 80 patients who were on a long-term HD program. The input variables were anamnestic data, body composition monitor (BCM) parameters, and echocardiography findings. The assessment of hydration status was determined by BCM, whose work is based on the principle of multifrequency bioimpedance spectroscopy. Another diagnostic procedure was the use of an arteriograph apparatus to assess PWV and Augmentation Index (AIx). All measurements were performed before and after dialysis on the middle dialysis day of the week.

Results:

The participants were divided into two groups based on hydration status: the experimental group consisted of 40 overhydrated participants and the control group consisted of 40 normovolemic participants. Statistically, the following BCM parameters correlated significantly positively with PWV: total body fat (r = 0.222; P < 0.05), overhydration (r = 0.290; P < 0.001), and relative overhydration (r = 0.290; P < 0.001). From echocardiography findings, only left atrial diameter correlated statistically significantly positively with PWV (r = 0.359; P < 0.001). Comparison of the mean PWV values within the experimental group before and after HD showed a statistically significant decrease from 14.32 ± 2.34 m/s to 8.72 ± 1.52 m/s (Z = 3.254; P = 0.0001). Mean PWV values within the control group did not decrease significantly from 13.39 ± 1.32 m/s to 10.39 ± 1.18 m/s (Z = 0.524; P = 0.742). If we compare the mean values of PWV between groups, then before HD treatment, there was no statistically significant difference between groups with PWV values in the experimental group of 14.32 ± 2.34 m/s and the control group of 13.39 ± 1.32 m/s (Z = 0.762; P = 0.852). According to the results of univariate regression analysis before and after HD treatment, only overhydration showed an absolute effect on PWV before and after HD.

Conclusion:

Overhydration showed an effect on brachial-ankle PWV before and after HD, and brachial-ankle PWV should be followed in HD patients.

Keywords:

Chronic kidney disease hemodialysis pulse wave velocity

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