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Updated: Jun 13, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Hemodynamic phenotypes in chronic kidney disease patients based on linear regression of blood pressure parameters
Katarzyna Cierpka-Kmieć1, Raissa Khursa2, Dagmara Hering1
1Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland.
Insights
Half of chronic kidney disease patients have a detrimental diastolic dysfunction hemodynamic phenotype. This "D" phenotype is linked to increased arterial stiffness and blood pressure variability, indicating potential circulatory issues.
Area of Science:
- Cardiovascular medicine
- Nephrology
- Biomedical engineering
Background:
- Chronic kidney disease (CKD) is associated with numerous cardiovascular (CV) risk factors, leading to vascular remodeling and abnormal hemodynamics.
- Identifying specific hemodynamic phenotypes in CKD patients is crucial for understanding their high CV risk.
Purpose of the Study:
- To determine hemodynamic phenotypes in patients with stage G3-G4 CKD using linear regression of blood pressure (BP) parameters.
- To investigate the association of these phenotypes with vascular stiffness and BP variability.
Main Methods:
- 52 patients with stage G3-G4 CKD underwent 24-hour ambulatory BP monitoring (ABPM), carotid-femoral pulse wave velocity (PWV) measurement, and central BP assessment.
- Hemodynamic phenotypes were derived using linear regression coefficients from ABPM data.
- Patients were categorized into harmonious (H) and diastolic dysfunctional (D) phenotypes.
Main Results:
- Twenty-six patients (50%) exhibited the diastolic dysfunctional (D) phenotype, while 26 (50%) showed the harmonious (H) phenotype.
- Patients with the D phenotype were older and had significantly higher PWV, ambulatory arterial stiffness index (AASI), systolic BP, and systolic BP variability (BPV) compared to the H phenotype.
- Estimated glomerular filtration rate (eGFR) did not differ significantly between the two phenotypes.
Conclusions:
- Approximately half of stage G3-G4 CKD patients present with an unfavorable diastolic dysfunctional (D) hemodynamic phenotype.
- This D phenotype is characterized by increased arterial stiffness and BP variability, suggesting a higher CV risk.
- Further research is needed to evaluate the clinical significance of these hemodynamic phenotypes in predicting circulatory disorders and patient outcomes.
Abstract:
Classic and non-classic cardiovascular (CV) risk factors accumulate in chronic kidney disease (CKD), contributing to vascular remodeling and hemodynamic abnormalities. This study aimed to determine hemodynamic phenotypes based on linear regression of blood pressure (BP) parameters in stage G3-G4 CKD patients at very high CV risk. 24-h ambulatory BP monitoring (ABPM), carotid-femoral pulse wave velocity (PWV) and central BP were obtained from 52 patients (aged 60 ± 11 years, BMI 30 ± 6 kg/m2) with stage G3-G4 CKD (eGFR 44 ± 12 mL/min./1.73 m2). Linear BP regression coefficients were generated to determine hemodynamic phenotypes using ABPM data. Coexisting hypertension was present in 45 (86%) patients, out of whom 33 (73%) had BP controlled. 24-h mean systolic/diastolic BP was 128 ± 18/75 ± 12 mm Hg. Twenty-six patients demonstrated the harmonious (H) and 26 patients diastolic dysfunctional (D) hemodynamic phenotypes. eGFR was not significantly different between both phenotypes. Compared to phenotype H, patients with phenotype D were older (57 ± 11 vs. 63 ± 10 years, p = .04), had higher PWV (8.2 [7.3-10.3] vs. 9.7 [8.3-10.9] m/s, p = .02), ambulatory arterial stiffness index (AASI) (0.31 ± 0.1 vs. 0.40 ± 0.1, p = .02), systolic BP (128 [122-130] vs. 137 [130-150] mm Hg, p = .001) and systolic BP variability (BPV) (11.7 ± 2.3 vs. 15.7 ± 3.4 mm Hg, p < .0001). Our findings suggest that one in two patients with stage G3-G4 CKD demonstrates an unfavorable D hemodynamic phenotype based on a linear regression model, associated with higher PWV, AASI, systolic BP, and systolic BPV. Further studies are required to assess the clinical utility of hemodynamic phenotypes and whether the D phenotype may predict latent circulatory disorders and outcomes.
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