The role of parameters of arterial stiffness to prognose cardiovascular survival in haemodialysis patients: determinants and therapeutic options
El Hadj Othmane Taha
Clinical Medicine
Dr. Fekete Andrea
SE I.sz. Belgyógyászati Klinika tanterme
2011-05-16 14:00:00
Molecular Genetics, Pathomechanism and Clinical Aspects of Metabolic Disorders
Prof. Lakatos Péter
Járai Zoltán
Dr. Páll Dénes - egyetemi docens
Dr. Földes Gábor - egyetemi adjunktus
Dr. Bérczi Viktor - egyetemi tanár
Dr. Becker Dávid - egyetemi adjunktus
Dr. Pécsvárady Zsolt - osztályvezető főorvos
In end-stage renal disease (ESRD) patients, calcification of the large arteries begins early, facilitating a 20- to 30-times higher rate of cardiovascular mortality (CV) than in the age-matched general population. In ESRD patients, the prognostic value of arterial stiffness parameters (pulse wave velocity: PWV, augmentation index: AI, central pulse pressure: CPP and carotid-femoral pulse pressure amplification: AMP) in one cohort for CV survival, the effect of phosphate binder sevelamer on aortic stiffness and the validation of the oscillometric device (Arteriograph) has not previously been examined. I have performed three studies in ESRD patients; the first examined the predictive power of different stiffness parameters for CV mortality evaluated in a single cohort. The second study assessed the effect of sevelamer on aortic stiffness, and the third evaluated the validity of Arteriograph device and the predictive value of measured parameters for CV mortality, compared to those of the reference PulsePen device. The first study showed that, pre- and postdialysis PWV and predialysis AMP values were related to CV mortality. In the second study, by the end of follow-up, PWV decreased in sevelamer-treated patients while it increased in controls. The direction of changes of AI was similar, although it did not reach the level of statistical significance. In the third study, AI values measured by the two devices showed statistically significant linear correlation, while for PWV similar correlation was not observed. Only PWV, measured by PulsePen, was related significantly to CV mortality. AI, measured by either of the devices, did not show a relationship with CV mortality. These results showed that in ESRD patients, among different stiffness parameters, PWV is consistently related to CV mortality, irrespective of the timing of measurement, predialysis AMP seems to provide additional prognostic information and that sevelamer treatment is associated with an improvement in aortic stiffness. Lack of correlation between PWV-values measured by the PulsePen and Arteriograph devices, and lack of prognostic significance of PWV measured by Arteriograph suggest limited validity of Arteriograph to determine PWV in patients on hemodialysis.
