FORTY-EIGHT HOUR AMBULATORY RECORDING OF ARTERIAL STIFFNESS IN PATIENTS ON HEMODIALYSIS

Abstract

Abstract Objective: Our aim was to analyze circadian pattern of arterials stiffness by measuring 48-hours augmentation index (AIx) and pulse wave velocity (PWV) in patients undergoing chronic hemodialysis (HD). Design and method: We enrolled 85 HD patients (mean age 58 (21–86), 48m and 37w) and 75 healthy control subjects (mean age of 64 (20–84), 40m and 35). All patients were dialyzed by the European and KDIGO guidelines. PWV and AIx were measured for 48-hours with Arteriograph starting at the mid-week dialysis session. PWV dippers = nighttime PWV drop > 0.5 m/s; PWV risers = nighttime PWV rise > 0.5 m/s compared to the daytime period. Aix dippers = nighttime Aix drop > 10percentage; Aix risers = nighttime Aix rise > 10% compared to daytime period. ABPM was performed with (SpaceLab 90207) after mid-week dialysis. Results: Average values of PWV and Aix did not differ between dialysis and non-dialysis day. Significantly more patients were dippers and risers of Aix and PWV on non-dialysis day vs. dialysis day (Aix dippers 12 vs 3, risers 35 vs 17; non-dippers 38 vs 65,; PWV dippers 38 vs 17, risers 24 vs 18, non-dippers 2 vs 50). PWV non-dippers and PWV risers had significantly higher ultrafiltration than PWV dippers. On logistic regression age and duration of hypertension had increased OR of 1.03 and 1.01 for AIx rising pattern on non-dialysis day while age and iPTH had increased OR of 1.06 and 1.03 or PWV rising pattern on non-dialysis day. When AIx and PWV circadian patterns were compared with control group of patients we found that significantly more control subjects had both AIx and PWV dipping patterns than HD patients while significantly more HD patients had both AIx and PWV rising patterns on the non-dialysis day. Conclusions: This pattern is more frequently present the day before than after dialysis. Age, duration of hypertension and iPTH were associated with this pattern and those patients required more ultrafiltration. Our results should be confirmed with larger number of patients in a multicentric study.