Membrane Bioincompatibility and Ultrafiltration Effects on Pulse Wave Analysis during Haemodialysis.

Maria-Pau Valenzuela,Jaume Almirall,María-José Amengual

doi:10.5402/2013/892315

Maria-Pau Valenzuela, Jaume Almirall + Show 1 more

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https://doi.org/10.5402/2013/892315

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Journal: ISRN nephrology	Publication Date: Dec 17, 2012
License type: CC BY 3.0

Affiliation: Parc Taulí Hospital Universitari

Abstract

Membrane bioincompatibility was demonstrated by successive white blood cell counts and C3a generation. Pulse wave analysis was obtained by applanation tonometry (SphygmoCor) in a sequential way: basal, after 30 minutes with nul ultrafiltration, and after a complete dialysis with ultrafiltration. At 15 minutes of haemodialysis, significant decrease in leukocyte count occurred: 6801 ± 1186 versus 4412 ± 1333 (P < 0.001), while C3a levels sharply increased from 427 ± 269 to 3501 ± 1638 ng/mL (P < 0.000). No changes were observed in augmentation index without ultrafiltration: 26.1 ± 11.1 versus 26.6 ± 12.4. Only aortic systolic blood pressure was lower at 15 minutes: 120.1 ± 17.7 versus 110.4 ± 25.8 mmHg (P = 0.009), in agreement with a reduction in brachial systolic blood pressure: 135.1 ± 18.1 versus 122.7 ± 27.4 mmHg (P = 0.01), without changes in aortic or brachial diastolic blood pressure. Important changes in pulse wave analysis were observed after a complete haemodialysis session: augmentation index 29.9 ± 10.1 versus 18.6 ± 15.0, aortic systolic blood pressure 139.8 ± 25.5 versus 119.4 ± 28.5 mmHg (P < 0.00), without changes in aortic diastolic blood pressure. In summary, haemodialysis with cellulose diacetate acutely induced a transient state of immunoactivation due to bioincompatibility, this phenomenon was nondetectable by pulse wave analysis. Complete haemodialysis session led to important changes in pulse wave analysis.

Highlights

Cardiovascular (CV) disease is the main cause of morbidity and mortality in patients with end-stage renal disease (ESRD). e increased risk is partly due to a higher prevalence of traditional CV risk factors
Another component that has been proposed to play a role in CV risk is the HD session per se. e dialysis procedure may induce acute functional alterations of the arterial wall through several mechanisms, the most remarkable being the intermittent immunoactivation state induced by dialysis [9,10,11], and the acute intravascular volume drop produced during the HD session [12,13,14,15,16,17]
A signi cant decrease in leukocyte count occurred at the beginning of dialysis: 6801 ± 1186 versus 4412 ± 1333 at 15 minutes (PP P PPPPP), while C3a levels sharply increased from 427 ± 269 to 3501 ± 1638 ng/mL at 15 minutes (PP P PPPPP), both parameters being inversely correlated

Summary

Introduction

Cardiovascular (CV) disease is the main cause of morbidity and mortality in patients with end-stage renal disease (ESRD). e increased risk is partly due to a higher prevalence of traditional CV risk factors. As in the general population, arterial stiffening has been described as an independent predictor of both CV and overall mortality in haemodialysis (HD) patients [2,3,4,5,6,7,8]. Another component that has been proposed to play a role in CV risk is the HD session per se. As PWA measurements are being increasingly introduced in the clinical setting, the main objective of our study was to separately analyze the acute effects on PWA of bioincompatibility and ultra ltration ( ) during the dialysis session

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Conclusion