Skip to main content
SpringerLink
Log in

Changes in arterial stiffness following dialysis in relation to overhydration and to endothelial function

  • Nephrology – Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Introduction

Cardiovascular (CV) morbidity and mortality are greatly enhanced in patients with chronic kidney disease, partly due to increased arterial stiffness.

Material and method

The study included 63 stable HD patients. Stiffness parameters were evaluated by applanation tonometry before the mid-week HD sessions. Pre-HD bioimpedance parameters were measured. A phase angle <six degrees was previously reported as abnormal, reflecting extracellular overhydration. Fluid status was evaluated echocardiographic by measuring the inferior vena cava (IVC) diameter. Endothelium-dependent and endothelium-independent vascular reactivity were assessed by changes in Alx following sublingual nitroglycerin and inhaled salbutamol.

Results

PWV directly correlated with patients’ age and dialysis vintage. Patients with a phase angle <6°, were significantly overhydrated (larger IVC, increased ECW, and lower ICW), had stiffer arteries and greater left ventricle mass (LVM), compared with those with a phase angle >6°. Overhydration increases arterial stiffness, but has no influence on either EID or ED vascular reactivity.

Conclusion

In hemodialysis, volume overload is an important contributor to increased arterial stiffness and modifies cardiovascular status especially by LV hypertrophy. Achieving normohydration may significantly ameliorate cardiac abnormalities and arterial stiffness and may impact major clinical events and CV mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY (2004) Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 35:1296–1305

    Article  Google Scholar 

  2. Lin YP, Yu WC, Hsu TL, Ding PYA, Yang WC, Chen CH (2003) The extracellular fluid-to-intracellular fluid volume ratio is associated with large-artery structure and function in hemodialysis patients. Am J Kidney Dis 42(5):990–999

    Article  PubMed  Google Scholar 

  3. Sutton-Tyrrell K, Samer SN, Boudreau RM et al (2005) A Health ABC Study. Elevated aortic pulse wave velocity, a marker of arterial stiffness, predicts cardiovascular events in well-functioning older adults. Circulation 111(25):3384–3390

    Article  PubMed  Google Scholar 

  4. Konings C, Hermans M, Kooman JP et al (2004) Arterial stiffness and renal replacement therapy. Perit Dial Int 4(4):318–322

    Google Scholar 

  5. Blacher J, Guerin AP, Pannier B, Marchais SJ, London GM et al (2001) Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease. Hypertension 38(4):938–942

    Article  PubMed  CAS  Google Scholar 

  6. Guérin AP, Pannier B, Métivier F, Marchais SJ, London GM (2008) Assessment and significance of arterial stiffness in patients with chronic kidney disease. Curr Opin Nephrol Hypertens (6):635–641

  7. Gusbeth-Tatomir P, Covic A (2007) Causes and consequences of increased arterial stiffness in chronic kidney disease patients. Kidney Blood Press Res 30:97–107

    Article  PubMed  Google Scholar 

  8. Chung A, Yang C, Kim JM et al (2010) Arterial stiffness and functional properties in chronic kidney disease patients on different dialysis modalities: an exploratory study. Nephrol Dial Transplant 25(12):4031–4404

    Article  PubMed  Google Scholar 

  9. van Guldener C, Janssen MJ, Lambert J et al (1998) No change in impaired endothelial function after long-term folic acid therapy of hyperhomocysteinaemia in haemodialysis patients. Nephrol Dial Transplant 13(1):106–112

    Article  PubMed  Google Scholar 

  10. Miyazaki H, Matsuoka H, Itabe H et al (2000) Hemodialysis impairs endothelial function via oxidative stress: effects of vitamin E-coated dialyzer. Circulation 101(9):1002–1006

    PubMed  CAS  Google Scholar 

  11. Kanbay M, Afsar B, Gusbeth-Tatomir P, Covic A (2010) Arterial stiffness in dialysis patients: where are we now? Int Urol Nephrol 42(3):741–752

    Article  PubMed  Google Scholar 

  12. Voroneanu L, Cusai C, Hogas S et al (2010) The relationship between chronic volume overload and elevated blood pressure in hemodialysis patients: use of bioimpedance provides a different perspective from echocardiography and biomarker methodologies. Int Urol Nephrol 42:789–797

    Google Scholar 

  13. Pillon L, Piccoli A, Lowrie EG, Lazarus JM, Chertow GM (2004) Vector length as a proxy for the adequacy of ultrafiltration in hemodialysis. Kidney Int 66:1266–1271

    Article  PubMed  Google Scholar 

  14. Kuhlmann MK, Zhu F, Seibert E, Levin NW (2005) Bioimpedance, dry weight and blood pressure control: new methods and consequences. Curr Opin Nephrol Hypertens 14(6):543–549

    Article  PubMed  Google Scholar 

  15. Segall L, Mardare NG, Ungureanu S et al (2009) Nutritional status evaluation and survival in haemodialysis patients in one centre from Romania. Nephrol Dial Transplant 24:2536–2540

    Article  PubMed  Google Scholar 

  16. Ganau A, Devereux RB, Roman JM et al (1992) Patterns of left ventricular hypertrophy and geometry remodelling in essential hypertension. J Am Coll Cardiol 19:1550–1558

    Article  PubMed  CAS  Google Scholar 

  17. Covic A, Goldsmith DJ, Panaghiu L et al (2000) Analysis of the effect of haemodialysis on peripheral and central arterial pressure waveforms. Kidney Int 57:2634–2643

    Article  PubMed  CAS  Google Scholar 

  18. Wilkinson IB, Hall IR, MacCallum H et al (2002) Pulse-wave analysis: clinical evaluation of a noninvasive, widely applicable method for assessing endothelial function. Arterioscler Thromb Vasc Biol 22:147–152

    Article  PubMed  CAS  Google Scholar 

  19. Wizemann V, Schilling M (1995) Dilemma of assessing volume state—the use and the limitations of a clinical score. Nephrol Dial Transplant 10(11):2114–2117

    PubMed  CAS  Google Scholar 

  20. Annuk M, Zilmer M, Lind L, Linde T, Fellstrom B (2001) Oxidative stress and endothelial function in chronic renal failure. J Am Soc Nephrol 12:2747–2752

    PubMed  CAS  Google Scholar 

  21. London GM, Guerin AP, Marchais SJ et al (1996) Cardiac and arterial interactions in end-stage renal disease. Kidney Int 50:600–608

    Article  PubMed  CAS  Google Scholar 

  22. Watabe D, Hashimoto J, Hatanaka R et al (2006) Electrocardiographic left ventricular hypertrophy and arterial stiffness: the Ohasama study. Am J Hypertens 19(12):1199–1205

    Article  PubMed  Google Scholar 

  23. Gardin JM, Arnold A, Gottdiener JS et al (1997) Left ventricular mass in the elderly: the Cardiovascular Health Study. Hypertension 29:1095–1103

    PubMed  CAS  Google Scholar 

  24. Gosse P, Jullien V, Jarnier P, Lemetayer P, Clementy J (1999) Reduction in arterial distensibility in hypertensive patients as evaluated by ambulatory measurement of the QKD interval is correlated with concentric remodeling of the left ventricle. Am J Hypertens 12(1–2):1252–1255

    Article  PubMed  CAS  Google Scholar 

  25. Roman MJ, Ganau A, Saba PS, Pini R, Pickering TG, Devereux RB (2000) Impact of arterial stiffening on left ventricular structure. Hypertension 36:489–494

    PubMed  CAS  Google Scholar 

  26. Aronson D, Burger AJ (2004) Relation between pulse pressure and survival in patients with decompensated heart failure. Am J Cardiol 93:785–788

    Article  PubMed  Google Scholar 

  27. Vlachopoulos C, Aznaouridis K, Stefanadis C (2010) Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol 55(13):1318–1327

    Article  PubMed  Google Scholar 

  28. London GM, Blacher J, Pannier B et al (2001) Arterial wave reflections and survival in end-stage renal failure. Hypertension 38:434–438

    PubMed  CAS  Google Scholar 

  29. London GM, Pannier B (2010) Arterial functions: how to interpret the complex physiology. Nephrol Dial Transplant 25:3815–3823

    Article  PubMed  Google Scholar 

  30. Goodman WG, London G, Amann K et al (2004) Vascular calcification in chronic kidney disease. Am J Kidney Dis 43:572–579

    Article  PubMed  Google Scholar 

  31. Ozkahya M, Ok E, Toz H et al (2006) Long-term survival rates in haemodialysis patients treated with strict volume control. Nephrol Dial Transplant 21:3506–3513

    Article  PubMed  Google Scholar 

  32. Santoro D, Bellinghieri G, Conti G et al (2010) Endothelial dysfunction in chronic renal failure. J Ren Nutr 20(5 Suppl):S103–S108

    Article  PubMed  CAS  Google Scholar 

  33. Duprez DA (2010) Is vascular stiffness a target for therapy? Cardiovasc Drugs Ther 24(4):305–310

    Article  PubMed  Google Scholar 

  34. Hornum M, Clausen P, Idorn T, Hansen JM, Mathiesen ER, Feldt-Rasmussen B (2010) Kidney transplantation improves arterial function measured by pulse wave analysis and endothelium-independent dilatation in uraemic patients despite deterioration of glucose metabolism. Nephrol Dial Transplant Nov 19 in press

  35. Zoungas S, Kerr PG, Chadban S et al (2004) Arterial function after successful renal transplantation. Kidney Int 65:1882–1889

    Article  PubMed  Google Scholar 

  36. Covic A, Goldsmith DJ, Gusbeth-Tatomir P et al (2003) Successful renal transplantation decreases aortic stiffness and increases vascular reactivity in dialysis patients. Transplantation 76:1573–1577

    Article  PubMed  CAS  Google Scholar 

  37. Rizos EC, Agouridis AP, Elisaf MS (2010) The effect of statin therapy on arterial stiffness by measuring pulse wave velocity: a systematic review. Curr Vasc Pharmacol 8(5):638–644

    Article  PubMed  CAS  Google Scholar 

  38. Fassett RG, Robertson IK, Ball MJ, Geraghty DP, Sharman JE, Coombes JS (2010) Effects of atorvastatin on arterial stiffness in chronic kidney disease: a randomised controlled trial. J Atherosclerosis Thrombosis 17(3):235–241

    Article  CAS  Google Scholar 

  39. Zhu F, Wystrychowski G, Kitzler T, Thijssen S, Kotanko P, Levin N (2006) Application of bioimpedance techniques to peritoneal dialysis. Contrib Nephrol 150:119–128

    Article  PubMed  CAS  Google Scholar 

  40. Crepaldi C, Soni S, Chionh CY, Wabel P, Cruz DN, Ronco C (2009) Application of body composition monitoring to peritoneal dialysis patients. Contrib Nephrol 163:1–6

    Article  PubMed  Google Scholar 

  41. Kuhlmann MK, Zhu F, Seibert E, Levin NW (2005) Bioimpedance, dry weight and blood pressure control: new methods and consequences. Curr Opin Nephrol Hypertens 14(6):543–549

    Article  PubMed  Google Scholar 

  42. Levin N, Zhu F, Seibert E, Ronco C, Kuhlmann M (2005) Use of segmental multifrequency bioimpedance spectroscopy in hemodialysis. Contrib Nephrol 149:162–167

    Article  PubMed  Google Scholar 

  43. Mallamaci F, Benedetto FA, Tripepi R et al (2010) Detection of pulmonary congestion by chest ultrasound in dialysis patients. J Am Coll Cardiol Img 3:586–594

    Google Scholar 

  44. Charra B, Terrat JC, Vanel T et al (2004) Long thrice weekly hemodialysis: the Tassin experience. Int J Artif Organs 27(4):265–283

    PubMed  CAS  Google Scholar 

  45. Kayikcioglu M, Tumuklu M, Ozkahya M et al (2009) The benefit of salt restriction in the treatment of end-stage renal disease by haemodialysis. Nephrol Dial Transplant 24:956–962

    Article  PubMed  Google Scholar 

  46. Volker Wizemann W, Wabel P, Chamney P et al (2009) The mortality risk of overhydration in haemodialysis patients. Nephrol Dial Transplant 24:1574–1579

    Article  PubMed  Google Scholar 

  47. Diaz-Buxo JA, Woods HF (2006) Protecting the endothelium: a new focus for management of chronic kidney disease. Hemodial Int 10(1):42–48

    Article  PubMed  Google Scholar 

  48. Stenvinkel P, Carrero JJ, Axelsson J, Lindholm B, Heimburger Massy Z (2008) Emerging biomarkers for evaluating cardiovascular risk in the chronic kidney disease patient: how do new pieces fit into the uremic puzzle? Clin J Am Soc Nephrol 3:505–521

    Article  PubMed  CAS  Google Scholar 

  49. Zoccalli C (2006) Endothelial dysfunction and the kidney: emerging risk factors for renal insufficiency and cardiovascular outcomes in essential hypertension. J Am Soc Nephrol 17(S6):1–3

    Google Scholar 

  50. Büssemaker E, Hillebrand U, Hausberg M, Pavenstädt H, Oberleithner H (2010) Pathogenesis of hypertension: interactions among sodium, potassium, and aldosterone. Am J Kidney Dis 55(6):1111–1120

    Article  PubMed  Google Scholar 

  51. Jablonski KL, Gates PE, Pierce GL, Seals DR (2009) Low dietary sodium intake is associated with enhanced vascular endothelial function in middle-aged and older adults with elevated systolic blood pressure. Ther Adv Cardiovasc Dis 3(5):347–356

    Article  PubMed  Google Scholar 

  52. Reuter S, Büssemaker E, Hausberg M, Pavenstädt H, Hillebrand U (2009) Effect of excessive salt intake: role of plasma sodium. Curr Hypertens Rep 11(2):91–97

    Article  PubMed  CAS  Google Scholar 

  53. Kanbay M, Chen Y, Solak Y, Sanders PW (2011) Mechanisms and consequences of salt sensitivity and dietary salt intake. Curr Opin Nephrol Hypertens 20(1):37–43

    Google Scholar 

  54. Sanders PW (2009) Vascular consequences of dietary salt intake. Am J Physiol Renal Physiol 297(2):F237–F243

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This work was supported from the Romanian state budget, by a research grant (PNCDI-II, program “IDEI”, code ID_1156), under the contractual authority of UEFISCSU (contract no. 392/2.10.2007).

Author information

Authors and Affiliations

  1. Clinic of Nephrology at “C. I. Parhon” University Hospital, “Gr. T. Popa” University of Medicine and Pharmacy, Bd. Carol I, Nr. 50, Iasi, 700503, Romania

    Simona Hogas, Serban Ardeleanu, Liviu Segall, Mugurel Apetrii, Mihai Onofriescu & Adrian Covic

  2. Department of Physiology, “Gr. T. Popa” University of Medicine and Pharmacy, Str. Universitatii, Nr. 16, Iasi, 700115, Romania

    Dragomir Nicolae Serban, Ionela Lacramioara Serban & Mihai Hogas

  3. Cardiology Department, “C. I. Parhon” University Hospital, “Gr. T. Popa” University of Medicine and Pharmacy, Bd. Carol I, Nr. 50, Iasi, 700503, Romania

    Radu Sascau

Authors
  1. Simona Hogas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Serban Ardeleanu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Liviu Segall
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dragomir Nicolae Serban
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ionela Lacramioara Serban
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mihai Hogas
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mugurel Apetrii
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mihai Onofriescu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Radu Sascau
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Adrian Covic
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Simona Hogas.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hogas, S., Ardeleanu, S., Segall, L. et al. Changes in arterial stiffness following dialysis in relation to overhydration and to endothelial function. Int Urol Nephrol 44, 897–905 (2012). https://doi.org/10.1007/s11255-011-9933-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-011-9933-x

Keywords

Search

Navigation