Electrolyte Blood Press.  2008 Dec;6(2):61-67. 10.5049/EBP.2008.6.2.61.

Clinical Factors Associated with Brachial-Ankle Pulse Wave Velocity in Patients on Maintenance Hemodialysis

• Kim EY
• Yi JH
• Han SW
• Shin J
• Lee JU
• Kim SG
• Kim HJ

• KMID: 2134807
• DOI: http://doi.org/10.5049/EBP.2008.6.2.61

Abstract

Pulse wave velocity (PWV) is a main parameter for arterial stiffness. In patients with end-stage renal disease (ESRD), PWV is known to be associated with increased mortality. But factors related to the increased PWV in ESRD patients are not well defined. In addition, the carotid-femoral PWV (cfPWV) measurement, which traditionally has been used to evaluate arterial stiffness, has low reproducibility. Recently, brachial-ankle PWV (baPWV) measurement, which can be performed more easily than cfPWV measurement, has become available as a means of measuring PWV. The aim of this study is to investigate the clinical factors associated with increased baPWV in ESRD patients. BaPWV was examined for 65 ESRD patients on maintenance hemodialysis during the period between the 7th to the 11th of February in 2005 using VP-1000. The clinical factors included age, sex, smoking history, blood pressure, diabetes, body mass index, interdialytic weight gain, duration of dialysis, lipid profile, uric acid, albumin, creatinine, C-reactive protein, calcium, phosphate, intact parathyroid hormone, and hematocrit were analyzed regarding associations (or to determine associations) with baPWV. The median age was 53.8+/-12.0, 31 males and 34 females. BaPWV was 18.9+/-5.2 m/s and there was no significant difference between gender (18.1+/-4.4 m/s vs 19.4+/-5.9 m/s, p=NS). In multiple regression models, age, predialysis systolic blood pressure, and diabetes were independent variables. In conclusion, age, systolic blood pressure, and diabetes were correlated with baPWV in ESRD patients. Thus baPWV measured by simple, noninvasive methods may become available for screening high risk groups in ESRD patients, although further longitudinal studies are necessary.

MeSH Terms

Atherosclerosis
Blood Pressure
Body Mass Index
C-Reactive Protein
Calcium
Creatinine
Dialysis
Female
Hematocrit
Humans
Kidney Failure, Chronic
Male
Mass Screening
Parathyroid Hormone
Pulse Wave Analysis
Renal Dialysis
Smoke
Smoking
Uric Acid
Vascular Stiffness
Weight Gain
C-Reactive Protein
Calcium
Creatinine
Parathyroid Hormone
Smoke
Uric Acid

Reference

1. Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis. 1998; 32:S112–S119. PMID: 9820470.

2. Kimoto E, Shoji T, Shinohara K, Inaba M, Okuno Y, Miki T, et al. Preferential stiffening of central over peripheral arteries in type 2 diabetes. Diabetes. 2003; 52:448–452. PMID: 12540620.

3. Guerin AP, London GM, Marchais SJ, Metivier F. Arterial stiffening and vascular calcifications in end-stage renal disease. Nephrol Dial Transplant. 2000; 15:1014–1021. PMID: 10862640.

4. Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM. Impact of aortic stiffness on survival in end-stage renal disease. Circulation. 1999; 99:2434–2439. PMID: 10318666.

5. Kitahara T, Ono K, Tsuchida A, Kawai H, Shinohara M, Ishii Y, et al. Impact of brachial-ankle pulse wave velocity and ankle-brachial blood pressure index on mortality in hemodialysis patients. Am J Kidney Dis. 2005; 46:688–696. PMID: 16183424.

6. Yamashina A, Tomiyama H, Takeda K, Tsuda H, Arai T, Hirose K, et al. Validity, reproducibility, and clinical significance of noninvasive brachial-ankle pulse wave velocity measurement. Hypertens Res. 2002; 25:359–364. PMID: 12135313.

7. Kim YK, Lee MY, Rhee MY. A simple oscillometric measurement of pulse wave velocity: Comparison with conventional tonometric measurement. Korean J Med. 2004; 67:597–606.

8. Guerin AP, Blacher J, Pannier B, Marchais SJ, Safar ME, London GM. Impact of aortic stiffness attenuation on survival of patients in end-stage renal failure. Circulation. 2001; 103:987–992. PMID: 11181474.

9. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986; 57:450–458. PMID: 2936235.

10. Munakata M, Sakuraba J, Tayama J, Furuta T, Yusa A, Nunokawa T, et al. Higher brachial-ankle pulse wave velocity is associated with more advanced carotid atherosclerosis in end-stage renal disease. Hypertens Res. 2005; 28:9–14. PMID: 15969249.

11. Yamashina A, Tomiyama H, Arai T, Hirose K, Koji Y, Hirayama Y, et al. Brachial-ankle pulse wave velocity as a marker of atherosclerotic vascular damage and cardiovascular risk. Hypertens Res. 2003; 26:615–622. PMID: 14567500.

12. Tomiyama H, Yamashina A, Arai T, Hirose K, Koji Y, Chikamori T, et al. Influences of age and gender on results of noninvasive brachial-ankle pulse wave velocity measurement--a survey of 12517 subjects. Atherosclerosis. 2003; 166:303–309. PMID: 12535743.

13. Lhee HY, Kim H, Lee KB, Lee Y. Serum Osteoprotegerin Levels and the Extent of Aortic Calcification in Hemodialysis Patients. Korean J Nephrol. 2006; 25:251–259.

14. Jani B, Rajkumar C. Ageing and vascular ageing. Postgrad Med J. 2006; 82:357–362. PMID: 16754702.

15. Shoji T, Emoto M, Shinohara K, Kakiya R, Tsujimoto Y, Kishimoto H, et al. Diabetes mellitus, aortic stiffness, and cardiovascular mortality in end-stage renal disease. J Am Soc Nephrol. 2001; 12:2117–2124. PMID: 11562410.

16. Tedesco MA, Natale F, Di Salvo G, Caputo S, Capasso M, Calabro R. Effects of coexisting hypertension and type II diabetes mellitus on arterial stiffness. J Hum Hypertens. 2004; 18:469–473. PMID: 14985776.

17. Suzuki E, Kashiwagi A, Nishio Y, Egawa K, Shimizu S, Maegawa H, et al. Increased arterial wall stiffness limits flow volume in the lower extremities in type 2 diabetic patients. Diabetes Care. 2001; 24:2107–2114. PMID: 11723092.

18. Uchida H, Nakamura Y, Kaihara M, Sugimoto T, Norii H, Sasaki M, et al. Practical efficacy of telmisartan for decreasing morning home blood pressure and pulse wave velocity in patients with mild-to-moderate hypertension. Hypertens Res. 2004; 27:545–550. PMID: 15492473.

19. Spittle MA, Hoenich NA, Handelman GJ, Adhikarla R, Homel P, Levin NW. Oxidative stress and inflammation in hemodialysis patients. Am J Kidney Dis. 2001; 38:1408–1413. PMID: 11728983.

20. Hausberg M, Kosch M, Stam F, Heidenreich S, Kisters K, Rahn KH, et al. Effect of fluvastatin on endothelium-dependent brachial artery vasodilation in patients after renal transplantation. Kidney Int. 2001; 59:1473–1479. PMID: 11260410.

21. Ichihara A, Hayashi M, Ryuzaki M, Handa M, Furukawa T, Saruta T. Fluvastatin prevents development of arterial stiffness in haemodialysis patients with type 2 diabetes mellitus. Nephrol Dial Transplant. 2002; 17:1513–1517. PMID: 12147804.