COMPARISON OF AMBULATORY CENTRAL HEMODYNAMICS AND ARTERIAL STIFFNESS IN HEMODIALYSIS PATIENTS WITH AND WITHOUT INTRADIALYTIC HYPERTENSION

Abstract

Objective: Increased arterial stiffness is suggested to be involved in the pathogenesis of intradialytic hypertension (IDH). Ambulatory pulse wave velocity (PWV) is an independent predictor for all-cause-mortality in hemodialysis patients and its prognostic power is better than office PWV. This is the first study comparing ambulatory central blood pressure (BP) and arterial stiffness parameters between patients with and without IDH. Design and method: This study examined 45 patients with IDH (defined as: SBP rise greater than or equal to 10 mmHg from pre- to post-dialysis and post-dialysis SBP greater than or equal to 150 mmHg) in comparison 197 without IDH. All participants underwent 48-h ABPM with the Mobil-O-Graph-NG device; parameters of central hemodynamics [central systolic (cSBP) and diastolic BP (cDBP), pulse pressure (PP)], wave reflection [augmentation index (AIx), and pressure (AP)] and PWV were estimated. Results: Age, dialysis vintage, interdialytic weight gain and prevalence of major comorbidities did not differ between the two study groups. Patients with IDH had higher 44-h cSBP (131.6 ± 16.7 vs. 119.3 ± 15.6, p < 0.001), 44-h cDBP (86.4 ± 12.8 vs. 79.3 ± 11.7, p < 0.001) and 44-h cPP (45.7 ± 10.7 vs. 40.3 ± 10.3, p = 0.002) levels compared to patients without IDH. Similarly, during day- and nighttime periods, cSBP/cDBP and cPP levels were higher in IDH patients compared to non-IDH. 44-h augmentation pressure and index, but not AIx(75) were higher in patients with IDH than those without IDH. 44-h PWV (10.0 ± 2.0 vs. 9.2 ± 2.1 m/s, p = 0.020) was significantly higher in patients with IDH. Conclusions: Patients with IDH have higher ambulatory central BP and increased arterial stiffness, as indicated by higher ambulatory cPP and PWV. Increased arterial stiffness could be a prominent factor associated with the high burden of cardiovascular disease in this population.