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Ambulatory recording of wave reflections and arterial stiffness during intra- and interdialytic periods in patients treated with dialysis.
Clin J Am Soc Nephrol. 2015 Apr 07; 10(4):630-8.CJ

Abstract

BACKGROUND AND OBJECTIVES

Wave reflections and arterial stiffness are independent cardiovascular risk factors in ESRD. Previous studies in this population included only static recordings before and after dialysis. This study investigated the variation of these indices during intra- and interdialytic intervals and examined demographic, clinical, and hemodynamic variables related to arterial function in patients undergoing hemodialysis.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Between February 2013 and May 2014, a total of 153 patients receiving maintenance hemodialysis in five dialysis centers of northern Greece underwent ambulatory BP monitoring with the newly introduced Mobil-O-Graph device (IEM, Stolberg, Germany) over a midweek dialysis session and the subsequent interdialytic period. Mobil-O-Graph is an oscillometric device that records brachial BP and pulse waves and estimates, via generalized transfer function, aortic BP, augmentation index (AIx) as a measure of wave reflections, and pulse wave velocity (PWV) as an index of arterial stiffness.

RESULTS

AIx was lower during dialysis than in the interdialytic period of dialysis-on day (Day 1) (mean±SD, 24.7%±9.7% versus 26.8%±9.4%; P<0.001). In contrast, PWV remained unchanged between these intervals (9.31±2.2 versus 9.29±2.3 m/sec; P=0.60). Both AIx and PWV increased during dialysis-off day (Day 2) versus the out-of-dialysis period of Day 1 (28.8%±9.8% versus 26.8%±9.4% [P<0.001] and 9.39±2.3 versus 9.29±2.3 m/sec [P<0.001]). Older age (odds ratio [OR], 1.09; 95% confidence interval [95% CI], 1.02 to 1.15), female sex (OR, 7.56; 95% CI, 1.64 to 34.81), diabetic status (OR, 8.84; 95% CI, 1.76 to 17.48), and higher mean BP (OR, 1.17; 95% CI, 1.09 to 1.27) were associated with higher odds of high AIx; higher heart rate was associated with lower odds (OR, 0.71; 95% CI, 0.63 to 0.80) of high AIx. Older age (OR, 2.04; 95% CI, 1.61 to 2.58) and higher mean BP (OR, 1.15; 95% CI, 1.05 to 1.27) were independent correlates of high PWV.

CONCLUSIONS

This study showed a gradual interdialytic increase in AIx, whereas PWV was only slightly elevated during Day 2. Future studies are needed to elucidate the value of these ambulatory measures for cardiovascular risk prediction in ESRD.

Authors+Show Affiliations

Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Greece;Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece; psarafidis11@yahoo.gr.Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Greece;Hypertension Unit & Cardiovascular Research Laboratory, "Laiko" Hospital, National and Kapodistrian University of Athens, Greece;Therapeutiki Hemodialysis Unit, Thessaloniki, Greece;Hemodialysis Unit, Achillopouleion General Hospital, Volos, Greece;Pieria Hemodialysis Unit, Katerini, Greece; and.Hemodialysis Unit, Serres General Hospital, Serres, Greece.Hemodialysis Unit, Achillopouleion General Hospital, Volos, Greece;Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Greece;Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece;Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Greece;

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

25635033

Citation

Karpetas, Antonios, et al. "Ambulatory Recording of Wave Reflections and Arterial Stiffness During Intra- and Interdialytic Periods in Patients Treated With Dialysis." Clinical Journal of the American Society of Nephrology : CJASN, vol. 10, no. 4, 2015, pp. 630-8.
Karpetas A, Sarafidis PA, Georgianos PI, et al. Ambulatory recording of wave reflections and arterial stiffness during intra- and interdialytic periods in patients treated with dialysis. Clin J Am Soc Nephrol. 2015;10(4):630-8.
Karpetas, A., Sarafidis, P. A., Georgianos, P. I., Protogerou, A., Vakianis, P., Koutroumpas, G., Raptis, V., Stamatiadis, D. N., Syrganis, C., Liakopoulos, V., Efstratiadis, G., & Lasaridis, A. N. (2015). Ambulatory recording of wave reflections and arterial stiffness during intra- and interdialytic periods in patients treated with dialysis. Clinical Journal of the American Society of Nephrology : CJASN, 10(4), 630-8. https://doi.org/10.2215/CJN.08180814
Karpetas A, et al. Ambulatory Recording of Wave Reflections and Arterial Stiffness During Intra- and Interdialytic Periods in Patients Treated With Dialysis. Clin J Am Soc Nephrol. 2015 Apr 7;10(4):630-8. PubMed PMID: 25635033.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ambulatory recording of wave reflections and arterial stiffness during intra- and interdialytic periods in patients treated with dialysis. AU - Karpetas,Antonios, AU - Sarafidis,Pantelis A, AU - Georgianos,Panagiotis I, AU - Protogerou,Athanase, AU - Vakianis,Pantelis, AU - Koutroumpas,Georgios, AU - Raptis,Vasileios, AU - Stamatiadis,Dimitrios N, AU - Syrganis,Christos, AU - Liakopoulos,Vassilios, AU - Efstratiadis,Georgios, AU - Lasaridis,Anastasios N, Y1 - 2015/01/29/ PY - 2014/08/17/received PY - 2015/01/05/accepted PY - 2015/1/31/entrez PY - 2015/1/31/pubmed PY - 2016/1/9/medline KW - Mobil-O-Graph KW - PWV KW - hemodialysis KW - interdialytic period KW - wave reflections SP - 630 EP - 8 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 10 IS - 4 N2 - BACKGROUND AND OBJECTIVES: Wave reflections and arterial stiffness are independent cardiovascular risk factors in ESRD. Previous studies in this population included only static recordings before and after dialysis. This study investigated the variation of these indices during intra- and interdialytic intervals and examined demographic, clinical, and hemodynamic variables related to arterial function in patients undergoing hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Between February 2013 and May 2014, a total of 153 patients receiving maintenance hemodialysis in five dialysis centers of northern Greece underwent ambulatory BP monitoring with the newly introduced Mobil-O-Graph device (IEM, Stolberg, Germany) over a midweek dialysis session and the subsequent interdialytic period. Mobil-O-Graph is an oscillometric device that records brachial BP and pulse waves and estimates, via generalized transfer function, aortic BP, augmentation index (AIx) as a measure of wave reflections, and pulse wave velocity (PWV) as an index of arterial stiffness. RESULTS: AIx was lower during dialysis than in the interdialytic period of dialysis-on day (Day 1) (mean±SD, 24.7%±9.7% versus 26.8%±9.4%; P<0.001). In contrast, PWV remained unchanged between these intervals (9.31±2.2 versus 9.29±2.3 m/sec; P=0.60). Both AIx and PWV increased during dialysis-off day (Day 2) versus the out-of-dialysis period of Day 1 (28.8%±9.8% versus 26.8%±9.4% [P<0.001] and 9.39±2.3 versus 9.29±2.3 m/sec [P<0.001]). Older age (odds ratio [OR], 1.09; 95% confidence interval [95% CI], 1.02 to 1.15), female sex (OR, 7.56; 95% CI, 1.64 to 34.81), diabetic status (OR, 8.84; 95% CI, 1.76 to 17.48), and higher mean BP (OR, 1.17; 95% CI, 1.09 to 1.27) were associated with higher odds of high AIx; higher heart rate was associated with lower odds (OR, 0.71; 95% CI, 0.63 to 0.80) of high AIx. Older age (OR, 2.04; 95% CI, 1.61 to 2.58) and higher mean BP (OR, 1.15; 95% CI, 1.05 to 1.27) were independent correlates of high PWV. CONCLUSIONS: This study showed a gradual interdialytic increase in AIx, whereas PWV was only slightly elevated during Day 2. Future studies are needed to elucidate the value of these ambulatory measures for cardiovascular risk prediction in ESRD. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/25635033/Ambulatory_recording_of_wave_reflections_and_arterial_stiffness_during_intra__and_interdialytic_periods_in_patients_treated_with_dialysis_ L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=25635033 DB - PRIME DP - Unbound Medicine ER -