A comparative study of oxidative stress, vascular calcification, and volume status in non-dippers and dippers receiving maintenance hemodialysis.

BACKGROUND

Hypertension is a leading cause of cardiovascular mortality in patients with end-stage kidney disease, with 80% to 90% of dialysis patients affected. Many patients with hypertension exhibit a non-dipper blood pressure pattern that is influenced by various factors. This study investigated the relationship between blood pressure patterns, volume status, vascular diseases, and oxidative stress markers.

METHODS

Forty-nine hemodialysis patients underwent 24-hour ambulatory blood pressure monitoring and were classified into "dipper" and "non-dipper" blood pressure groups. Laboratory tests, bioimpedance analysis, carotid ultrasound, and ankle-brachial index (ABI) measurements were performed, including baseline myeloperoxidase (MPO) and fetuin-A level assessments.

RESULTS

Eleven patients were classified as dippers and 38 as non-dippers. The non-dipper group exhibited higher nighttime systolic blood pressure, consistent with their lack of nocturnal blood pressure decline. Further, this group had significantly elevated MPO levels (2.5 ng/mL vs. 1.5 ng/mL, p = 0.03) and accounted for all recorded deaths. No significant differences were found between the two groups regarding volume status, intima-media thickness, carotid artery calcification, or ABI.

CONCLUSION

Most hemodialysis patients exhibited a non-dipper pattern, which was significantly associated with increased MPO levels, suggesting a role of oxidative stress. There was no significant association with fluid overload, peripheral arterial disease, or vascular calcification. Further research is needed to explore the impact of oxidative stress on the non-dipper pattern in the hypertensive hemodialysis population.