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Hemodialysis patients with intradialytic rise in blood pressure display higher baseline aortic stiffness and negligible drop in augmentation index with dialysis

  • Nephrology - Original Paper
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Abstract

Background

In hemodialysis patients, the intradialytic rise in blood pressure (BP) is associated with increased mortality risk. However, the mechanisms of this adverse effect are not yet elucidated. This study examined whether intradialytic rise in BP is associated with increased arterial stiffness and wave reflections, which are powerful cardiovascular risk predictors in hemodialysis.

Methods

The pattern of intradialytic hemodynamic response was evaluated in 70 prevalent hemodialysis patients, by measuring seated brachial BP before and after the mid-week dialysis session. All patients had pre- and post-dialysis determination of aortic pulse wave velocity (PWV) and heart rate-adjusted augmentation index [AIx(75)], as measures of arterial stiffness and wave reflections, with the Sphygmocor device.

Results

Intradialytic rise in brachial systolic BP (SBP) was evident in 17 patients, whereas intradialytic change in SBP (ΔSBP) of −10 to 0 mmHg was observed in 23 and ΔSBP greater than −10 mmHg in 30 patients. Participants with intradialytic SBP rise had significantly higher pre-dialysis aortic PWV (10.4 ± 1.6 vs 8.3 ± 1.9 vs 9.4 ± 2.4 m/s, P < 0.01) and AIx(75) (28.1 ± 7.3 vs 21.7 ± 8.6 vs 25.8 ± 8.2 %, P < 0.05) than those experiencing intradialytic ΔSBP of −10 to 0 and greater than −10 mmHg, respectively. Patients with rise in SBP during dialysis exhibited also lower intradialytic reduction in AIx(75) (−1.5 ± 4.9 vs −5.4 ± 5.9 vs −6.7 ± 5.3 %, P < 0.001).

Conclusions

This study shows that aortic stiffness and wave reflections are higher and not affected by dialysis procedure in patients with intradialytic SBP rise, suggesting that accelerated arteriosclerosis may be one possible explanation for the heightened cardiovascular risk associated with intradialytic hypertension.

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Funding

This study was not supported by any source and represents an original effort of our part.

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Authors and Affiliations

  1. Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloníki, Greece

    Panagiotis I. Georgianos, Fani Mpoutsiouki, Vassilios Liakopoulos, Elias V. Balaskas & Pantelis E. Zebekakis

  2. Hemodialysis Unit, General Hospital of Serres, Serres, Greece

    Panagiotis I. Georgianos & Dimitrios N. Stamatiadis

  3. Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece

    Erasmia Sabani & Pantelis A. Sarafidis

Authors
  1. Panagiotis I. Georgianos
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  2. Fani Mpoutsiouki
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  3. Erasmia Sabani
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  4. Dimitrios N. Stamatiadis
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  5. Vassilios Liakopoulos
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  6. Elias V. Balaskas
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  7. Pantelis E. Zebekakis
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  8. Pantelis A. Sarafidis
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Correspondence to Panagiotis I. Georgianos.

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All procedures performed in studies were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Georgianos, P.I., Mpoutsiouki, F., Sabani, E. et al. Hemodialysis patients with intradialytic rise in blood pressure display higher baseline aortic stiffness and negligible drop in augmentation index with dialysis. Int Urol Nephrol 48, 601–608 (2016). https://doi.org/10.1007/s11255-015-1205-8

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  • DOI: https://doi.org/10.1007/s11255-015-1205-8

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