title: Ambulatory recording of wave reflections and arterial stiffness during intra- and interdialytic periods in patients treated with dialysis.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Between February 2013 and May 2014, a total of 153 patients receiving maintenance hemodialysis in five dialysis centers of northern Greece underwent ambulatory BP monitoring with the newly introduced Mobil-O-Graph device (IEM, Stolberg, Germany) over a midweek 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.
  
  
  RESULTS
  AIx was lower during dialysis than in the interdialytic period of dialysis-on day (Day 1) (mean±SD, 24.7%±9.7% versus 26.8%±9.4%; P<0.001). In contrast, PWV remained unchanged between these intervals (9.31±2.2 versus 9.29±2.3 m/sec; P=0.60). Both AIx and PWV increased during dialysis-off day (Day 2) versus the out-of-dialysis period of Day 1 (28.8%±9.8% versus 26.8%±9.4% [P<0.001] and 9.39±2.3 versus 9.29±2.3 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 associated with higher odds of high AIx; higher heart rate was associated with 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.
authors: Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Greece;
authors: Antonios
authors: A
authors: Karpetas
authors: Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece; psarafidis11@yahoo.gr.
authors: Pantelis A
authors: PA
authors: Sarafidis
authors: Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Greece;
authors: Panagiotis I
authors: PI
authors: Georgianos
authors: Hypertension Unit & Cardiovascular Research Laboratory, "Laiko" Hospital, National and Kapodistrian University of Athens, Greece;
authors: Athanase
authors: A
authors: Protogerou
authors: Therapeutiki Hemodialysis Unit, Thessaloniki, Greece;
authors: Pantelis
authors: P
authors: Vakianis
authors: Hemodialysis Unit, Achillopouleion General Hospital, Volos, Greece;
authors: Georgios
authors: G
authors: Koutroumpas
authors: Pieria Hemodialysis Unit, Katerini, Greece; and.
authors: Vasileios
authors: V
authors: Raptis
authors: Hemodialysis Unit, Serres General Hospital, Serres, Greece.
authors: Dimitrios N
authors: DN
authors: Stamatiadis
authors: Hemodialysis Unit, Achillopouleion General Hospital, Volos, Greece;
authors: Christos
authors: C
authors: Syrganis
authors: Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Greece;
authors: Vassilios
authors: V
authors: Liakopoulos
authors: Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece;
authors: Georgios
authors: G
authors: Efstratiadis
authors: Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Greece;
authors: Anastasios N
authors: AN
authors: Lasaridis
mesh_terms: D000368:Aged; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory / Q000295:instrumentation; D015924:Blood Pressure Monitors; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D016009:Chi-Square Distribution; D004867:Equipment Design; D005260:Female; D006115:Greece; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009991:Oscillometry; D011237:Predictive Value of Tests; D063177:Pulse Wave Analysis / Q000295:instrumentation; D006435:Renal Dialysis / Q000009:adverse effects; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D059289:Vascular Stiffness
keywords: Mobil-O-Graph; PWV; hemodialysis; interdialytic period; wave reflections
references: J Hum Hypertens. 2005 Jun;19(6):439-44
references: 15660121
references: Circulation. 1999 May 11;99(18):2434-9
references: 10318666
references: J Am Coll Cardiol. 2005 Nov 1;46(9):1753-60
references: 16256881
references: J Am Soc Nephrol. 2006 Jul;17(7):2034-47
references: 16738019
references: Eur Heart J. 2006 Nov;27(21):2588-605
references: 17000623
references: J Hypertens. 2007 Feb;25(2):265-72
references: 17211229
references: Clin J Am Soc Nephrol. 2006 May;1(3):389-98
references: 17699236
references: Am J Kidney Dis. 2009 Nov;54(5):788-91
references: 19853196
references: Hypertension. 2010 Mar;55(3):762-8
references: 20083728
references: J Am Coll Cardiol. 2010 Mar 30;55(13):1318-27
references: 20338492
references: Nephrol Dial Transplant. 2010 May;25(5):1579-83
references: 20031931
references: Blood Press Monit. 2010 Aug;15(4):225-8
references: 20216407
references: J Hum Hypertens. 2010 Aug;24(8):498-504
references: 20237499
references: Blood Press Monit. 2010 Aug;15(4):229-31
references: 20658764
references: Hypertension. 2011 Nov;58(5):825-32
references: 21911710
references: Hypertension. 2011 Nov;58(5):765-7
references: 21911711
references: Am J Nephrol. 2011;34(5):407-14
references: 21934301
references: Semin Dial. 2012 Jan-Feb;25(1):1-8
references: 22273522
references: Am J Nephrol. 2012;35(3):238-41
references: 22343708
references: Am J Hypertens. 2012 Aug;25(8):876-82
references: 22673021
references: Kidney Int. 2012 Aug;82(4):388-400
references: 22534962
references: Kidney Int. 2000 Jun;57(6):2634-43
references: 10844634
references: Nephrol Dial Transplant. 2001 Aug;16(8):1663-8
references: 11477171
references: Hypertension. 2001 Sep;38(3):434-8
references: 11566918
references: Blood Press Monit. 2013 Jun;18(3):173-6
references: 23571229
references: Nephrol Dial Transplant. 2013 Aug;28(8):2160-9
references: 23645477
references: Int J Cardiol. 2013 Oct 25;169(1):57-61
references: 24063914
references: J Hypertens. 2014 Apr;32(4):899-903
references: 24609217
references: J Hypertens. 2014 Jul;32(7):1359-66
references: 24886823
references: J Am Soc Nephrol. 2014 Aug;25(8):1630-46
references: 24700870
references: Am J Nephrol. 2014;40(3):242-50
references: 25322847
references: Hypertension. 2002 Mar 1;39(3):735-8
references: 11897754
references: J Am Soc Nephrol. 2002 Jan;13(1):177-83
references: 11752035
references: Curr Vasc Pharmacol. 2015;13(2):229-38
references: 24007427
references: Nephrol Dial Transplant. 2002 Oct;17(10):1713-24
references: 12270974
references: N Engl J Med. 2004 Sep 23;351(13):1296-305
references: 15385656
references: J Hum Hypertens. 2005 Jun;19(6):425-7
references: 15759026