Patients with mild or moderate chronic kidney disease (CKD) are know to have a significant increase in cardiovascular morbidity in which alterations in large arterial as well as endothelial function may play a role. In the present study, we investigated the relationship between glomerular filtration rate (GFR), augmentation index and endothelial function. Cross sectional study with healthy controls (CONT, n =16), patients with essential hypertension (EH, n = 14), and those with essential hypertension and peripheral artery disease (EH+PAD, n = 26). The effect of postocclusive reactive hyperemia (PORH; 220 mmHg, 3 min,

According to previous studies different parameters characterize arterial stiffness relate to cardiovascular mortality in patients on haemodialysis. However, its relative prognostic value and the optimal time of measurement have not previously been examined in one cohort. The carotid-femoral pulse wave velocity (PWV), the carotid augmentation index (AI), the carotid pulse pressure (CPP) and the carotid-brachial pulse pressure amplification (AMP) were determined in 98 patients before and after haemodialysis procedure. Patients were followed for 29 months (median; range 1–34) and the association of these parameters with the risk of cardiovascular mortality was assessed using log-rank tests and Cox proportional hazards regression. During follow-up, 25 patients died of cardiovascular causes. Increasing pre-and postdialysis PWV tertiles and decreasing predialysis AMP tertiles were significantly related to cardiovascular mortality (p = 0.012 and 0.011 for PWV, respectively; and <0.001 for AMP). Neither the AI nor CPP was related to cardiovascular mortality. The adjusted hazard ratios for 1 m/s higher pre-and postdialysis PWV were 1.24 (1.07–1.44) and 1.17 (1.06–1.28), respectively. The hazard ratio for 10

BACKGROUNDThe method of estimating distance traveled by the pulse wave, used in the calculation of pulse wave velocity (PWV), is not standardized. Our objective was to assess whether different methods of distance measurement influenced the association of PWV to cardiovascular mortality in hemodialysis (HD) patients.METHODSNinety-eight chronic HD patients had their PWV measured using three methods for distance estimation; PWV1: suprasternal notch-to-femoral site minus suprasternal notch-to-carotid site, PWV2: carotid-to-femoral site, PWV3: carotid-to-femoral site minus suprasternal notch-to-carotid site. Carotid-to-femoral distance was used to approximate torso length. Patients were followed for a median of 30 months and the association of PWV and cardiovascular mortality was assessed using survival analysis before and after stratification for torso length.RESULTSThe three methods resulted in significantly different PWV values. During follow-up 50 patients died, 32 of cardiovascular causes. In log-rank tests, only tertiles of PWV1 was significantly related to outcome (P values 0.017, 0.257, 0.137, for PWV1, PWV2, and PWV3, respectively). In adjusted Cox, proportional hazards regression only PWV1 was related to cardiovascular mortality. In stratified analysis, however, among patients with below median torso length all PWV values were related to outcome, whereas in patients with above median torso length none of the PWV methods resulted in significant relationship to outcome.CONCLUSIONSPWV calculated using suprasternal notch-to-femoral distance minus suprasternal notch-to-carotid distance provides the strongest relationship to cardiovascular mortality. Longer torso weakens the predictive value of PWV, possibly due to more tortuosity of the aorta hence, more error introduced when using surface tape measurements.

Assessment of arterial stiffness in dialysis patients has prognostic significance. The TensioClinic device uses oscillometrically obtained wave forms to calculate pulse wave velocity (PWV) and augmentation index (AI). Our objective was assess the validity of measurements of TensioClinic (PWVT, AIT) compared to that of the validated PulsePen tonometer (PWVP, AIP). We measured PWV and AIx in duplicate, before and after hemodialysis, in 94 hemodialysis patients. Reliability of a given device was assessed by calculating the standard deviation of the difference (SDD) between the first and second measurement. Validity of TensioClinic was evaluated by comparing its results to that obtained by the PulsePen device, using correlation analysis and Bland-Altman plots. Predialysis SDD for PWVP and PWVT were –0.03±0.94 m/s and 0.51±1.35 m/s, postdialysis PWVP and PWVT SDD-s were 0.09±1.419 m/s and 0.07±1.81 m/s, respectively. Pre- and postdialysis SDD for AIP and AIT were 0.87±5.49

Arterial stiffness is an independent predictor of cardiovascular morbidity and mortality in hemodialysis (HD) patients. Determinants of arterial stiffness and its change during HD are not well characterized, and it is not known if parameters of calcium-phosphate metabolism predict arterial wall properties. We measured carotid-femoral pulse wave velocity (PWV) and carotid augmentation index (AI) before and after HD in 96 chronic HD patients using the PulsePen device. Detailed medical history was taken and blood drawn for routine biochemistry before and after HD. Determinants of PWV and AI and their corresponding changes during HD were assessed by stepwise forward multivariate linear regression models. Mean pre- and postdialysis PWV was 11.0 ± 2.9 and 11.6 ± 2.9 m/s (P = 0.004) respectively. Mean pre- and postdialysis AI was 23.5 ± 12.2 and 22.1 ± 12.4% (P = NS). Significant and independent predictors of predialysis PWV (R for the whole model = 0.79) were higher age, systolic blood pressure and CRP level, lower serum sodium level, and the presence of peripheral artery disease. Predictors of predialysis AI (R = 0.42) were higher systolic blood pressure and higher time averaged creatinine value. The increase in PWV during dialysis was independently associated (R = 0.53) with lower predialysis PWV, higher baseline heart rate, higher urea level and systolic blood pressure change during dialysis. Change in AI during dialysis was significantly and negatively associated (R = 0.55) with predialysis AI and the heart rate change during dialysis. Our results confirm previously described predictors of PWV and AI. Parameters of calcium-phosphate metabolism do not seem to influence arterial stiffness before or after dialysis. The relation of serum sodium level to predialysis PWV may imply volume overload that is to be explored.