title: Hemodialysis patients with intradialytic rise in blood pressure display higher baseline aortic stiffness and negligible drop in augmentation index with dialysis.
abstract: BACKGROUND
  In hemodialysis patients, the intradialytic rise in blood pressure (BP) is associated with increased mortality risk. However, the mechanisms of this adverse effect are not yet elucidated. This study examined whether intradialytic rise in BP is associated with increased arterial stiffness and wave reflections, which are powerful cardiovascular risk predictors in hemodialysis.
  
  
  METHODS
  The pattern of intradialytic hemodynamic response was evaluated in 70 prevalent hemodialysis patients, by measuring seated brachial BP before and after the mid-week dialysis session. All patients had pre- and post-dialysis determination of aortic pulse wave velocity (PWV) and heart rate-adjusted augmentation index [AIx(75)], as measures of arterial stiffness and wave reflections, with the Sphygmocor device.
  
  
  RESULTS
  Intradialytic rise in brachial systolic BP (SBP) was evident in 17 patients, whereas intradialytic change in SBP (ΔSBP) of -10 to 0 mmHg was observed in 23 and ΔSBP greater than -10 mmHg in 30 patients. Participants with intradialytic SBP rise had significantly higher pre-dialysis aortic PWV (10.4 ± 1.6 vs 8.3 ± 1.9 vs 9.4 ± 2.4 m/s, P < 0.01) and AIx(75) (28.1 ± 7.3 vs 21.7 ± 8.6 vs 25.8 ± 8.2%, P < 0.05) than those experiencing intradialytic ΔSBP of -10 to 0 and greater than -10 mmHg, respectively. Patients with rise in SBP during dialysis exhibited also lower intradialytic reduction in AIx(75) (-1.5 ± 4.9 vs -5.4 ± 5.9 vs -6.7 ± 5.3%, P < 0.001).
  
  
  CONCLUSIONS
  This study shows that aortic stiffness and wave reflections are higher and not affected by dialysis procedure in patients with intradialytic SBP rise, suggesting that accelerated arteriosclerosis may be one possible explanation for the heightened cardiovascular risk associated with intradialytic hypertension.
authors.affiliation: Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloníki, Greece. pangeorgi@yahoo.gr.|Hemodialysis Unit, General Hospital of Serres, Serres, Greece. pangeorgi@yahoo.gr.
authors.forename: Panagiotis I
authors.initials: PI
authors.lastname: Georgianos
authors.affiliation: Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloníki, Greece.
authors.forename: Fani
authors.initials: F
authors.lastname: Mpoutsiouki
authors.affiliation: Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece.
authors.forename: Erasmia
authors.initials: E
authors.lastname: Sabani
authors.affiliation: Hemodialysis Unit, General Hospital of Serres, Serres, Greece.
authors.forename: Dimitrios N
authors.initials: DN
authors.lastname: Stamatiadis
authors.affiliation: Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloníki, Greece.
authors.forename: Vassilios
authors.initials: V
authors.lastname: Liakopoulos
authors.affiliation: Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloníki, Greece.
authors.forename: Elias V
authors.initials: EV
authors.lastname: Balaskas
authors.affiliation: Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloníki, Greece.
authors.forename: Pantelis E
authors.initials: PE
authors.lastname: Zebekakis
authors.affiliation: Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece.
authors.forename: Pantelis A
authors.initials: PA
authors.lastname: Sarafidis
mesh_terms: D001013:Aorta, Thoracic / Q000503:physiopathology*; D001783:Blood Flow Velocity / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006115:Greece / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D063177:Pulse Wave Analysis; D006435:Renal Dialysis; D059289:Vascular Stiffness / Q000502:physiology*
keywords: Arterial stiffness; Augmentation index; Intradialytic BP; Pulse wave velocity; Wave reflections