Chonnam Med J.  2020 Jan;56(1):27-35. 10.4068/cmj.2020.56.1.27.

Impacts of Coronary Artery Calcification on Intradialytic Blood Pressure Patterns in Patients Receiving Maintenance Hemodialysis

• Yeo S
• Moon JI
• Shin J
• Hwang JH
• Cho I
• Kim SH

• KMID: 2468143
• DOI: http://doi.org/10.4068/cmj.2020.56.1.27

Abstract

Intradialytic blood pressure abnormalities are associated with adverse outcomes in patients with end-stage renal disease on dialysis. Vascular calcification is a common complicating feature, but whether this complication results in intradialytic blood pressure abnormalities remains uncertain. Therefore, this study investigated the relationship between coronary artery calcium score and intradialytic blood pressure abnormalities in patients with end-stage renal disease on maintenance hemodialysis. Thirty-six patients who received nongated chest computed tomography scans were included. Intradialytic hypotension was defined as a minimum intradialytic systolic blood pressure of <100 mmHg or a pre-dialysis blood pressure - minimum intradialytic systolic blood pressure >30 mmHg. Intradialytic hypertension was defined as >10 mmHg increase in systolic blood pressure (pre- to post-dialysis). Patients were classified as 22 (61.1%) with coronary artery calcium score <400 and 14 (38.9%) with coronary artery calcium score ≥400. Median systolic and diastolic blood pressures were equivalent, but median pulse pressure was higher in patients with coronary artery calcium score ≥400 than in those with scores <400. Coronary artery calcium score was comparable according to both intradialytic hypotension and hypertension, and had no correlation with systolic blood pressure fall and nadir systolic blood pressure. Coronary artery calcium score predicted the occurrence of cardiovascular events and all-cause mortality (hazard ratio 1.001 and 1.001; p=0.058 and 0.010). Coronary vascular calcification could be irrelevant to intradialytic blood pressure abnormalities in patients with end-stage renal disease on dialysis.

Keyword

Vascular Calcification; Dialysis; Blood Pressure; Hypotension; Hypertension

MeSH Terms

Blood Pressure*
Calcium
Coronary Vessels*
Dialysis
Humans
Hypertension
Hypotension
Kidney Failure, Chronic
Mortality
Renal Dialysis*
Thorax
Vascular Calcification
Calcium

Figure

• 

  FIG. 1 BP measurements over the course of dialysis treatment according to the CACS group. (A, B) Median systolic and diastolic BPs changed from 146/73 mmHg pre-dialysis to 142/77 mmHg post-dialysis in the CACS <400 group; on the other hand, BPs changed from 157/61 mmHg to 149/67 mmHg in the CACS ≥400 group. Patients with CACS ≥400 had slightly higher systolic BPs and lower diastolic BPs than those with CACS <400 (p for systolic BPs = 0.061, 0.017, 0.227, 0.377, and 0.071; p for diastolic BPs = 0.083, 0.095, 0.066, 0.053, and 0.049). (C) Median pulse pressures over the dialysis treatment were wider in the CACS ≥400 group compared to the CACS <400 group (p=0.010, 0.002, 0.011, 0.011, and 0.002). Pulse pressure at pre-dialysis was 71 (55, 80) mmHg in the CACS <400 group and 81 (76, 106) mmHg in the CACS ≥400 group; Pulse pressure then changed to 68 (55, 76) mmHg and 85 (72, 99) mmHg at post-dialysis in the two groups, respectively. BP: blood pressure, CACS: coronary artery calcium score. *p<0.05.

• 

  FIG. 2 CACS according to the presence of intradialytic hypotension or hypertension. Median CACS was compared between patients with and without intradialytic BP abnormalities. CACS of patients with intradialytic hypotension (Nadir100 or Fall30) was 237 (62, 1416) or 237 (37, 1314), respectively, and these were similar to those without the complication (Nadir100: CACS 295 [80, 1318]; p=1.000; Fall30: CACS 314 [119, 1348]; p=0.661). In addition, CACS was 350 (37, 1458) in patients with intradialytic hypertension and 194 (82, 1316) in those without intradialytic hypertension (p=0.626). Intradialytic hypotension is defined as a minimum intradialytic systolic BP <100 mmHg (Nadir100) or pre-dialytic systolic BP − minimum intradialytic systolic BP ≥30 mmHg (Fall30). Intradialytic hypertension is defined as an increase in systolic BP ≥10 mmHg. BP: blood pressure, CACS: coronary artery calcium score.

• 

  FIG. 3 Correlation of CACS with intradialytic systolic BP fall or nadir systolic BP. (A, B) Correlation was analyzed to find whether CACS influences the degree of systolic BP fall or the lowest systolic BP during the dialysis treatment. Linear regression analyses showed that CACS was not associated with either intradialytic systolic BP fall or nadir systolic BP (r=0.2 and 0.1; p=0.277 and 0.415). Intradialytic systolic BP fall refers to pre-dialytic systolic BP − minimum intradialytic systolic BP. Nadir systolic BP refers to minimum intradialytic systolic BP. BP: blood pressure, CACS: coronary artery calcium score.

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