ARTERIAL STIFFNESS CIRCADIAN PATTERN AND CARDIOVASCULAR MORTALITY IN HEMODIALYZED PATIENTS

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Objective: Our aim was to analyze association of circadian pattern of 48-hours pulse wave velocity (PWV) and augmentation index (AIx) with cardiovascular (CV) mortality in patients undergoing chronic hemodialysis (HD). Design and method: 85 patients (mean age, 48m; 37w) were followed-up until for 36-months or till the time of death. Blood pressure (BP) (Omron M6), 48-h PWV and AIx (Arteriograph) and 24-h ABPM (SpaceLab 90207)-both after mid-week dialysis session were measured in all patients. PWV dippers = night-time PWV drop > 0.5 m/s; PWV risers = night-time PWV rise > 0.5 m/s compared to the day-time period. Aix dippers= night-time Aix drop > 10%; Aix risers= night-time Aix rise > 10% compared to day-time period. Results: After 36 months of follow-up, CV mortality was 49.4% (men 57.1%, women 42.9%). Deceased patients were older when enrolled and when had started with dialysis (both p < 0.001). There were no differences in prevalence of hypertension (100% vs. 95.3%), diabetes (23.8% vs. 11.6%) and number of hypertensive drugs (3.51 vs. 3.23) between two groups (all p > 0.05). Deceased patients had significantly longer duration of hypertension (p < 0.01) as well as significantly higher proportion of AIx and PWV risers and higher nocturnal AIx levels than survived patients. On the non-dialysis day both nocturnal AIx and PWV levels were higher in deceased group with significantly more AIx and PWV dippers when compared to survivors. PWV risers were significantly older when enrolled and when started with dialysis and had significantly higher ultrafiltration rates than PWV non-risers and survived significantly shorter. In the linear regression model survival was negatively associated with age, duration of hypertension, ultrafiltration but the strongest association was with AIx and PWV risers on the non-dialysis day. On logistic regression only PWV rising pattern on non-dialysis day had increased HR of 1.78 [CI 1.60, 1.96] for CV mortality. Conclusions: Non-rising patterns of PWV and AIx on non-dialysis days were significantly associated with CV mortality in patients undergoing chronic HD. Our data confirmed importance of 48-hour measurements of PWV and Aix in prediction of CV mortality.