Aortic pulse wave velocity in haemodialysis patients is associated with the prescription of active vitamin D analogues
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Cardiovascular disease remains the most common cause of death for haemodialysis patients. In addition to traditional cardiovascular risk factors, haemodialysis patients have additional risk factors, including vascular calcification. Pulse wave velocity (PWV) is a measurement of arterial stiffness, and we wished to determine whether PWV is affected by different factors in haemodialysis patients compared to the general population.
Aortic PWV was measured in 303 adult patients attending for routine outpatient dialysis.
303 patients, 63.4 % male, mean age 68.5 ± 15.8 years, 47.5 % diabetic with a body mass index of 25.8 ± 5.3 kg/m2, were studied. Systolic blood pressure (SBP) was 148.7 ± 28.6 mmHg and diastolic 80.4 ± 15.3 mmHg. Aortic PWV was 9.73 ± 2.08 m/s, and was correlated with SBP (β 0.015, F 5.29, p = 0.023), log serum parathyroid hormone (PTH) (β 1.58, F 13.85, p < 0.001) and prescription of alfacalcidol (β −1.11, F 6.81, p = 0.010). 197 patients had corresponding ECHO cardiograms, and in this cohort PWV was associated with SBP (β 0.017, F 7.49, p = 0.006), log serum parathyroid hormone (β 0.85, F 5.99, p < 0.015) and prescription of alfacalcidol (β −0.8, F 4.18, p = 0.042), left ventricular mass index (LVMI) (β 0.01, F 11.4, p = 0.001), and log serum triglycerides (β 1.43, F 4.79, p = 0.03).
We found that PWV, a measurement of arterial stiffness, was associated with both traditional cardiovascular risk factors, including SBP and LVMI, but also non-traditional risk factors such as prescription of active vitamin D analogues, suggesting a potential link between vascular calcification and arterial stiffness in haemodialysis patients.
KeywordsHypertension Haemodialysis Parathyroid hormone Vitamin D Pulse wave velocity
- 6.Horváth IG, Németh A, Lenkey Z, Alessandri N, Tufano F, Kis P, Gaszner B, Cziráki A (2010) Invasive validation of a new oscillometric device (Arteriograph) for measuring augmentation index, central blood pressure and aortic pulse wave velocity. J Hypertens 28(10):2068–2075PubMedCrossRefGoogle Scholar
- 14.Moran N, Buscombe J, Davenport A (2008) Predicting cardiac events using adenosine triphosphate myocardial perfusion scintography in renal transplant candidates. J Nephrol Renal Transplant 1:41–52Google Scholar
- 16.Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise J, Solomon S, Spencer KT, St John Sutton M, Stewart W (2006) American Society of Echocardiography’s Nomenclature and Standards Committee; Task Force on Chamber Quantification; American College of Cardiology Echocardiography Committee; American Heart Association; European Association of Echocardiography, European Society of Cardiology. Recommendations for chamber quantification. Eur J Echocardiogr 7(2):79–108PubMedCrossRefGoogle Scholar
- 17.Davenport A. Differences in prescribed Kt/V and delivered haemodialysis dose—why obesity makes a difference to survival for haemodialysis patients when using a ‘one size fits all’ Kt/V target. Nephrol Dial Transplant. 2013. PMID: 23787543Google Scholar
- 18.Nemcsik J, Egresits J, El Hadj Othmane T, Fekete BC, Fodor E, Szabó T, Járai Z, Jekkel C, Kiss I, Tislér A (2009) Validation of arteriograph—a new oscillometric device to measure arterial stiffness in patients on maintenance haemodialysis. Kidney Blood Press Res 32(3):223–229PubMedCrossRefGoogle Scholar
- 25.Shigenaga A, Tamura K, Dejima T, Ozawa M, Wakui H, Masuda S, Azuma K, Tsurumi-Ikeya Y, Mitsuhashi H, Okano Y, Kokuho T, Sugano T, Ishigami T, Toya Y, Uchino K, Tokita Y, Umemura S (2009) Effects of angiotensin II type 1 receptor blocker on blood pressure variability and cardiovascular remodelling in hypertensive patients on chronic peritoneal dialysis. Nephron Clin Pract 112(1):c31–c40PubMedCrossRefGoogle Scholar
- 27.Noordzij M, Cranenburg EM, Engelsman LF, Hermans MM, Boeschoten EW, Brandenburg VM, Bos WJ, Kooman JP, Dekker FW, Ketteler M, Schurgers LJ, Krediet RT, Korevaar JC, NECOSAD Study Group (2011) Progression of aortic calcification is associated with disorders of mineral metabolism and mortality in chronic dialysis patients. Nephrol Dial Transplant 26(5):1662–1669PubMedCrossRefGoogle Scholar
- 30.Townsend RR, Chirinos JA, Parsa A, Weir MA, Sozio SM, Lash JP, Chen J, Steigerwalt SP, Go AS, Hsu CY, Rafey M, Wright JT Jr, Duckworth MJ, Gadegbeku CA, Joffe MP, Chronic Renal Insufficiency Cohort Investigators (2010) Central pulse pressure in chronic kidney disease: a chronic renal insufficiency cohort ancillary study. Hypertension 56(3):518–524PubMedCentralPubMedCrossRefGoogle Scholar
- 31.Jung JY, Hwang YH, Lee SW, Lee H, Kim DK, Kim S, Oh YG, Yang J, Joo KW, Ahn C, Oh KH. Factors associated with aortic stiffness and its change over time in peritoneal dialysis patientsGoogle Scholar
- 32.Shoji T, Shinohara K, Kimoto E, Emoto M, Tahara H, Koyama H, Inaba M, Fukumoto S, Ishimura E, Miki T, Tabata T, Nishizawa Y (2004) Lower risk for cardiovascular mortality in oral 1α-hydroxy vitamin D3 users in a haemodialysis population. Nephrol Dial Transplant 19:179–184PubMedCrossRefGoogle Scholar