The Association of Arterial Stiffness and Intradialytic Hypotension in Patients on Maintenance Hemodialysis Can be Predicted with the Measurement of Automated Brachial-Ankle Pulse Wave Velocity (baPWV)

Abstract

Measurements of brachial-ankle PWV by non-invasive device is a simple and easy tool for the stiffness of aorta and peripheral arteries. Factors related to the increased baPWV in end-stage renal disease (ESRD) patients are not well defined. The aim of this study is to investigate the clinical factors associated with increased baPWV in patients on maintenance hemodialysis. Sixty-five ESRD patients on low flux maintenance hemodialysis were enrolled. BaPWV were determined using automated oscillometric method (VP-1000, Colin). Clinical factors were analyzed regarding the association with PWV. Intradialytic hypotension (IDH) was defined as systolic blood pressure less than 100 mmHg and/or symptoms associated with hypotension, or any intervension about hypotension. Patients characteristics: age, 53.9 ± 12.0 yrs; male, 48%; diabetes, 26 (40%); smoking history, 22 (34%); RAS blockades group, 19 (29%); Statins group, 18 (28%); pre- and post-dialysis systolic blood pressure (SBP), 169.1 ± 14.1 mmHg, 150.3 ± 16.0 mmHg; dialysis vintage median [25-75% quartile], 3.2 [1.4-4.9] yrs; IDH median, 5.4 [1.5-12.1] /100 sessions. BaPWV were correlated with age, pre- and post-dialysis SBP, total cholesterol, HDL-cholesterol, LDL-cholesterol, uric acid, serum creatinine and fasting glucose. After adjustment for age and postdialysis SBP, only IDH (r=0.27, P<0.05) was significantly correlated with baPWV. In the comparison of baPWV according to categorical variables, such as gender, diabetes, smoking history, RAS blockades and statins, there were no differences between dichotomous variables. In multiple regression model, age (β=0.294), postdialysis SBP (β=0.458) and intradialytic hypotension (β=0.243) were independent variables (R2=0.401). In ESRD patients on hemodialysis, intradialytic hypotension was independently associated with baPWV, along with traditional cardiovascular risk factors, such as age and systolic blood pressure. Among multifactorial factors, arterial stiffness may be a cause of intradialytic hypotension in ESRD patients on hemodialysis.