A prospective observational study comparing a non-operator dependent automatic PWV analyser to pulse pressure, in assessing arterial stiffness in hemodialysis

Igor Salvadé, Sibylle Schätti-Stählin, Eleonora Violetti, Carlo Schönholzer, Claudio Cereghetti, Hugo Zwahlen, Lorenzo Berwert, Michel Burnier, Luca Gabutti, Igor Salvadé, Sibylle Schätti-Stählin, Eleonora Violetti, Carlo Schönholzer, Claudio Cereghetti, Hugo Zwahlen, Lorenzo Berwert, Michel Burnier, Luca Gabutti

Abstract

Background: Chronic kidney disease (CKD) accelerates vascular stiffening related to age. Arterial stiffness may be evaluated measuring the carotid-femoral pulse wave velocity (PWV) or more simply, as recommended by KDOQI, monitoring pulse pressure (PP). Both correlate to survival and incidence of cardiovascular disease. PWV can also be estimated on the brachial artery using a Mobil-O-Graph; a non-operator dependent automatic device. The aim was to analyse whether, in a dialysis population, PWV obtained by Mobil-O-Graph (MogPWV) is more sensitive for vascular aging than PP.

Methods: A cohort of 143 patients from 4 dialysis units has been followed measuring MogPWV and PP every 3 to 6 months and compared to a control group with the same risk factors but an eGFR > 30 ml/min.

Results: MogPWV contrarily to PP did discriminate the dialysis population from the control group. The mean difference translated in age between the two populations was 8.4 years. The increase in MogPWV, as a function of age, was more rapid in the dialysis group. 13.3% of the dialysis patients but only 3.0% of the control group were outliers for MogPWV. The mortality rate (16 out of 143) was similar in outliers and inliers (7.4 and 8.0%/year). Stratifying patients according to MogPWV, a significant difference in survival was seen. A high parathormone (PTH) and to be dialysed for a hypertensive nephropathy were associated to a higher baseline MogPWV.

Conclusions: Assessing PWV on the brachial artery using a Mobil-O-Graph is a valid and simple alternative, which, in the dialysis population, is more sensitive for vascular aging than PP. As demonstrated in previous studies PWV correlates to mortality. Among specific CKD risk factors only PTH is associated with a higher baseline PWV.

Trial registration: ClinicalTrials.gov Identifier: NCT02327962.

Figures

Figure 1
Figure 1
Pulse Pressure and age. Pulse Pressure progression as a function of age in both groups (P between groups n.s.).
Figure 2
Figure 2
Pulse Wave Velocity and age. MogPWV progression as a function of age in both groups. Native values above (P between groups n.s.); after adjusting by systolic blood pressure below (P between groups <0.001).
Figure 3
Figure 3
Pulse Wave Velocity and survival. Survival as a function of MogPWV. Kaplan-Meier curve depicting the probability of survival in two subgroups of MogPWV (P 0.02; Relative risk 2.96).
Figure 4
Figure 4
Pulse Wave Velocity and dialysis duration. Surface-plot showing the relationship among months on dialysis, age and MogPWV.
Figure 5
Figure 5
Pulse Wave Velocity at the inclusion and follow up visits. MogPWV are systolic blood pressure adjusted (above) and unadjusted (below) values respectively. 0: inclusion visits for subjects of the control and dialysis groups respectively; 1–7: follow-up visits for the dialysis group. Values are given in mean; SD is depicted.
Figure 6
Figure 6
Comparison of MogPWV progression rate between survivors and deceased of the dialysis group. MogPWV are systolic blood pressure adjusted values. 1–5: follow-up visits. None of the deceased was evaluated at visit 6 and 7. Values are given in mean; SD is depicted.
Figure 7
Figure 7
Relationship between MogPWV and Ultrafiltration. A correlation was not demonstrated.

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