International urology and nephrology · 2011
Changes in arterial stiffness following dialysis in relation to overhydration and to endothelial function.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Hogas Simona, Ardeleanu Serban, Segall Liviu, Serban Dragomir Nicolae, Serban Ionela Lacramioara, Hogas Mihai, Apetrii Mugurel, Onofriescu Mihai, Sascau Radu, Covic Adrian
Аннотация
INTRODUCTION: Cardiovascular (CV) morbidity and mortality are greatly enhanced in patients with chronic kidney disease, partly due to increased arterial stiffness.
MATERIAL AND METHOD: The study included 63 stable HD patients. Stiffness parameters were evaluated by applanation tonometry before the mid-week HD sessions. Pre-HD bioimpedance parameters were measured. A phase angle <six degrees was previously reported as abnormal, reflecting extracellular overhydration. Fluid status was evaluated echocardiographic by measuring the inferior vena cava (IVC) diameter. Endothelium-dependent and endothelium-independent vascular reactivity were assessed by changes in Alx following sublingual nitroglycerin and inhaled salbutamol.
RESULTS: PWV directly correlated with patients' age and dialysis vintage. Patients with a phase angle <6°, were significantly overhydrated (larger IVC, increased ECW, and lower ICW), had stiffer arteries and greater left ventricle mass (LVM), compared with those with a phase angle >6°. Overhydration increases arterial stiffness, but has no influence on either EID or ED vascular reactivity.
CONCLUSION: In hemodialysis, volume overload is an important contributor to increased arterial stiffness and modifies cardiovascular status especially by LV hypertrophy. Achieving normohydration may significantly ameliorate cardiac abnormalities and arterial stiffness and may impact major clinical events and CV mortality.
MATERIAL AND METHOD: The study included 63 stable HD patients. Stiffness parameters were evaluated by applanation tonometry before the mid-week HD sessions. Pre-HD bioimpedance parameters were measured. A phase angle <six degrees was previously reported as abnormal, reflecting extracellular overhydration. Fluid status was evaluated echocardiographic by measuring the inferior vena cava (IVC) diameter. Endothelium-dependent and endothelium-independent vascular reactivity were assessed by changes in Alx following sublingual nitroglycerin and inhaled salbutamol.
RESULTS: PWV directly correlated with patients' age and dialysis vintage. Patients with a phase angle <6°, were significantly overhydrated (larger IVC, increased ECW, and lower ICW), had stiffer arteries and greater left ventricle mass (LVM), compared with those with a phase angle >6°. Overhydration increases arterial stiffness, but has no influence on either EID or ED vascular reactivity.
CONCLUSION: In hemodialysis, volume overload is an important contributor to increased arterial stiffness and modifies cardiovascular status especially by LV hypertrophy. Achieving normohydration may significantly ameliorate cardiac abnormalities and arterial stiffness and may impact major clinical events and CV mortality.
Предметные рубрики MeSH
Adrenergic beta-2 Receptor AgonistsAdultAgedAlbuterolAnalysis of VarianceBlood Flow VelocityBody WaterEchocardiographyElectric ImpedanceEndotheliumFemaleHeart VentriclesHumansLinear ModelsMaleManometryMiddle AgedMultivariate AnalysisNitroglycerinPulseRenal DialysisRenal Insufficiency, ChronicVascular StiffnessVasodilator AgentsVena Cava, Inferior