Ambulatory aortic blood pressure, wave reflections and pulse wave velocity are elevated during the third in comparison to the second interdialytic day of the long interval in chronic haemodialysis patients.
BACKGROUND
Increased arterial stiffness and aortic blood pressure (BP) are independent predictors of cardiovascular outcomes in end-stage renal disease. The 3-day interdialytic interval is associated with elevated risk of cardiovascular morbidity and mortality in haemodialysis. This study investigated differences in ambulatory aortic BP and arterial stiffness between the second and third day of the long interdialytic interval.


METHODS
Ambulatory BP monitoring with Mobil-O-Graph monitor (IEM, Stolberg, Germany) was performed in 55 haemodialysis patients during a 3-day interval. Mobil-O-Graph records oscillometric brachial BP and pulse waves and calculates aortic BP and augmentation index (AIx) as measure of wave reflections, and pulse wave velocity (PWV) as measure of arterial stiffness.


RESULTS
Ambulatory aortic systolic blood pressure (SBP) and diastolic blood pressure (DBP) were higher during the third versus second interdialytic day (123.6 ± 17.0 versus 118.5 ± 17.1 mmHg, P < 0.001; 81.5 ± 11.8 versus 78 ± 11.9 mmHg, P < 0.001, respectively). Similar differences were noted for brachial BP. Ambulatory AIx and PWV were also significantly increased during the third versus second day (30.5 ± 9.9 versus 28.8 ± 9.9%, P < 0.05; 9.6 ± 2.3 versus 9.4 ± 2.3 m/s, P < 0.001, respectively). Differences between Days 2 and 3 remained significant when day-time and night-time periods were compared separately. Aortic SBP and DBP, AIx and PWV showed gradual increases from the end of dialysis session onwards. Interdialytic weight gain was a strong determinant of the increase in the above parameters.


CONCLUSIONS
This study showed significantly higher ambulatory aortic BP, AIx and PWV levels during the third compared with the second interdialytic day. These findings support a novel pathway for increased cardiovascular risk during the third interdialytic day in haemodialysis.
Hemodialysis Unit, Achillopouleion General Hospital, Volos, Greece.
Georgios
G
Koutroumbas
Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Panagiotis I
PI
Georgianos
Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Pantelis A
PA
Sarafidis
Hypertension Unit and Cardiovascular Research Laboratory, 'Laiko' Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Athanase
A
Protogerou
Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Antonios
A
Karpetas
Therapeutiki Hemodialysis Unit, Thessaloniki, Greece.
Pantelis
P
Vakianis
Pieria Hemodialysis Unit, Katerini, Greece.
Vassilios
V
Raptis
Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Vassilios
V
Liakopoulos
Department of Nephrology, Alexandroupolis Hospital, Democritus University, Alexandroupolis, Greece.
Stylianos
S
Panagoutsos
Hemodialysis Unit, Achillopouleion General Hospital, Volos, Greece.
Christos
C
Syrganis
Department of Nephrology, Alexandroupolis Hospital, Democritus University, Alexandroupolis, Greece.
Ploumis
P
Passadakis
D001011:Aorta / Q000503:physiopathology*; D062186:Arterial Pressure / Q000502:physiology; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000503:physiopathology*; D016022:Case-Control Studies; D002908:Chronic Disease; D005260:Female; D005858:Germany; D006339:Heart Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D063177:Pulse Wave Analysis; D006435:Renal Dialysis; D012307:Risk Factors; D013997:Time Factors
Mobil- O-Graph; aortic pressure; augmentation index; pulse wave velocity; three-day interdialytic interval