Ambulatory recording of wave reflections and arterial stiffness during intra- and interdialytic periods in patients treated with dialysis

Abstract

Background and objectives Wave reflections and arterial stiffness are independent cardiovascular risk factors in ESRD. Previous studies in this population included only static recordings before and after dialysis. This study investigated the variation of these indices during intra- and interdialytic intervals and examined demographic, clinical, and hemodynamic variables related to arterial function in patients undergoing hemodialysis. Design, setting, participants, & measurements Between February 2013 and May 2014, a total of 153 patients receiving maintenance hemodialysis in five dialysis centers of northern Greece underwent ambulatory BP monitoringwith the newly introducedMobil-O-Graph device (IEM, Stolberg,Germany) over amidweek dialysis session and the subsequent interdialytic period. Mobil-O-Graph is an oscillometric device that records brachial BP and pulse waves and estimates, via generalized transfer function, aortic BP, augmentation index (AIx) as a measure of wave reflections, and pulse wave velocity (PWV) as an index of arterial stiffness. ResultsAIxwas lower during dialysis than in the interdialytic period of dialysis-on day (Day 1) (mean±6SD, 24.7% 69.7% versus 26.8%69.4%; P<0.001). In contrast, PWV remained unchanged between these intervals (9.31±62.2 versus 9.29±62.3 m/sec; P=0.60). Both AIx and PWV increased during dialysis-off day (Day 2) versus the out-ofdialysis period of Day 1 (28.8%±69.8% versus 26.8%±69.4% [P<0.001] and 9.39±62.3 versus 9.29±62.3 m/sec [P<0.001]). Older age (odds ratio [OR], 1.09; 95%confidence interval [95% CI], 1.02 to 1.15), female sex (OR, 7.56; 95%CI, 1.64 to 34.81), diabetic status (OR, 8.84; 95%CI, 1.76 to 17.48), and higher mean BP (OR, 1.17; 95%CI, 1.09 to 1.27)were associatedwith higher odds of highAIx; higher heart ratewas associatedwith lower odds (OR, 0.71; 95%CI, 0.63 to 0.80) of high AIx. Older age (OR, 2.04; 95%CI, 1.61 to 2.58) and higher mean BP (OR, 1.15; 95%CI, 1.05 to 1.27) were independent correlates of high PWV. Conclusions This study showed a gradual interdialytic increase in AIx, whereas PWV was only slightly elevated during Day 2. Future studies are needed to elucidate the value of these ambulatory measures for cardiovascular risk prediction in ESRD.