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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE  
Year : 2021  |  Volume : 32  |  Issue : 2  |  Page : 336-340
Comparison of changes in pulse wave velocity in patients on peritoneal dialysis and hemodialysis


1 Department of Nephrology, Dialysis and Transplantation, La Rabta Hospital, Tunis, Tunisia
2 Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
3 Department of Nephrology, Dialysis and Transplantation, La Rabta Hospital; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
4 Research Department Renal Disease Laboratory (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia

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Date of Web Publication11-Jan-2022
 

   Abstract 


Cardiovascular disease is the leading cause of death of dialyzed patients. Aortic stiffness, evaluated by the carotid-femoral pulse wave velocity (cfPWV), is now considered as a prognostic factor for cardiovascular mortality in patients with chronic kidney diseases. The peritoneal dialysis (PD) patients had significantly stiffer arteries. cfPWV was 9.12 ± 2.7 m/s in PD patients without significant correlation compared to hemodialysis (HD) patients (8.97 ± 2.52 m/s). In the univariate study, we found a statistically significant correlation between PWV and age (P = 0), between the pulse wave velocity and phosphorus (P = 0.46), between the VOP and PTH (P = 0.013) and between PWV and dyslipidemia (P = 0.014). Other variables such as phospho-calcic product, hemoglobin, total cholesterol, and KT/V were not significant. To identify the risk factors independently linked to the event, we conducted a multi-varied analysis. A correlation was found between VOP and dyslipidemia (P = 0.008). The other variables were insignificant.

How to cite this article:
Barrah S, Kheder RE, Jebali H, Krid M, Smaoui W, Beji S, Hmida FB, Fatma LB, Zouaghi MK. Comparison of changes in pulse wave velocity in patients on peritoneal dialysis and hemodialysis. Saudi J Kidney Dis Transpl 2021;32:336-40

How to cite this URL:
Barrah S, Kheder RE, Jebali H, Krid M, Smaoui W, Beji S, Hmida FB, Fatma LB, Zouaghi MK. Comparison of changes in pulse wave velocity in patients on peritoneal dialysis and hemodialysis. Saudi J Kidney Dis Transpl [serial online] 2021 [cited 2022 Jan 25];32:336-40. Available from: https://www.sjkdt.org/text.asp?2021/32/2/336/335444



   Introduction Top


Cardiovascular disease is the leading cause of death of dialyzed patients. The links between dialysis and the constitution of vascular lesions are numerous and complex. The high prevalence of cardiovascular disease in these patients cannot be explained solely by traditional cardiovascular risk factors such as diabetes mellitus, hypertension, smoking, dyslipidemia, and smoking. Additional nontraditional risks factors related to chronic kidney diseases (CKD) and to dialysis, such as anemia, inflammation, malnutrition, and oxidant stress can contribute to the increased cardiovascular death risk. Aortic stiffness, evaluated by the carotid-femoral pulse wave velocity (cfPWV), is now considered a prognostic factor for cardiovascular mortality in patients with CKD. An accelerated cfPWV is correlated to an increased risk of stroke and cardiovascular death. Whether dialysis modality can influence arterial wall properties and though aortic stiffness has barely been reported. The aim of our study was to compare the effect of dialysis modality on the aortic stiffness in patients undergoing peritoneal (PD) and hemodialysis (HD) and to correlate it to clinical and biological characte-ristics of these two populations.


   Patients and Methods Top


The study included 48 adult patients: 26 on HD and 22 on PD, all treated in ambulatory way at a nephrology and dialysis unit in Tunis, Tunisia with at least six months vintage. Patients on HD had three sessions/week, via an arterio-venous fistula or a permanent catheter. PD patients were all on automated nocturnal PD using standard glucose solution. Excluding criteria were patients who initiated dialysis <6 months before being investigated for the study, patients with current history of infection or malignancy. Patients’ personal, demographic and medical history data were collected from their source document. During a study visit, the same and single investigator recorded the patients’ weight and length, and a three supine average of blood pressure using an electronic device (Omron). cfPWV had been assessed using a Complior device, on the day of a routine appointment in PD patients and on the mid-week HD session in HD patients. The Complior device uses mechanotransductors to measure the velocity of the pulse wave between two sites. CfPWV is considered the gold standard in evaluating aortic stiffness. Laboratory routine measurements had also been assessed (serum creatinine, calcium phosphorus, hemoglobin, white blood cells count, CRP, albumin, ferritinemia).

Results are expressed as frequencies and percentages for categorical variables and median for continuous non-normally distributed variables.


   Results Top


Our study included 48 patients, 26 in hemo-dialysis and 22 in PD. The two groups were comparable regarding age and sex ratio. Vintage in dialysis were significantly longer in HD patients (41.19 mo HD vs. 27.45 mo in PD; P <0.05). Residual daily urine volume was higher in PD patients with P <0.01. Demographic and laboratory data, BP levels, and antihypertensive regimens are shown in [Table 1],[Table 2],[Table 3].
Table 1: Demographic data

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Table 2: Laboratory data.

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Table 3: Antihypertensive regimens.

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The mean BP in HD patients was lower than in PD patients, but the difference did not achieve statistical significance. However, the use of anti-hypertensive drugs was significantly higher in PD patients, especially for calcium channel blockers (P<0.01). However, the mean serum total cholesterol was significantly higher in PD patients than in HD patients (2.34 g/L vs. 1.2 g/L, respectively; P <0.01), and KT/V was significantly lower in HD patients.

The PD patients had significantly stiffer arteries. cfPWV was 9.12 ± 2.7 m/s in PD patients without significant correlation compared to HD patients (8.97 ± 2.52 m/s).

A comparison of the Augmentation Index (AIx) between HD and PD is presented in [Table 4]. Again, the highest AIx was recorded in PD patients.
Table 4: Group statistics.

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In the univariate study, we found a statistically significant correlation between PWV and age (P = 0), between the VOP and phosphorus (P = 0.46), between the VOP and PTH (P = 0.013), and between PWV and dyslipidemia (P = 0.014). Other variables such as phosphocalcic product, hemoglobin, total cholesterol and Kt/V were not significant.

To identify the risk factors independently linked to the event, we conducted a multi-varied analysis. A correlation was found between VOP and dyslipidemia (P = 0.008). The other variables were insignificant.


   Discussion Top


The understanding of the cardiovascular disease of the dialysis came with the identification and characterization of a structural modification of the arteries namely, arterio-sclerosis.[1] Arteriosclerosis, affecting the media and the adventitia, leads to arterial stiffness. This arterial stiffness is evaluated by pulse wave velocity (PWV). Arteriosclerosis is an arterial degenerative process met during physiological aging but much stronger in certain pathological circumstances such high blood pressure, diabetes, or chronic kidney disease, especially terminal.[2] This arterial stiffness in dialysis patients is probably explained by several risk factors, called “non-traditional” such as anemia, oxidative stress, uremic toxins, disturbances of phosphocalcic metabolism, and other metabolic abnormalities inherent to chronic renal failure.[3]

Theoretically, compared with HD, PD possesses several hemodynamic advantages: it is a continuous depuration process, and it maintains a stable intravascular volume with minimal electrolyte shifts and minimal changes in BP.[4] However, few studies have compared the prevalence of vascular abnormalities between patients on HD and those on PD.

Measurements of aortic stiffness [aortic pulse wave velocity (PWV) and augmentation index (AIx)] have been established as powerful predictors of survival on dialysis. Abnormal endothelial-dependent and endothelial-independent vascular reactivity and increased arterial stiffness are commonly described in HD patients. There is, however, a lack of information on the comparative impact of different renal replacement therapies (RRT) (PD) on PWV and AIx, and how these different methods might influence endothelial-dependent abnormal vasodilatation.[4],[5],[6]

In this study, we found that the subjects on PD had stiffer arteries and more profoundly abnormal vasomotor function than the subjects on HD, despite a shorter period on RRT. Indeed, recent studies, in sharp contrast with older literature, described more severe left ventricular hypertrophy in PD patients compared to their HD.

Despite numerous potentially relevant factors contributing to arterial stiffness (arteriosclerosis, vessel calcifications, etc.), the present study suggests that greater fluctuations in BP predialysis and post-dialysis might be involved in the progression of arterial stiffness in patients on HD.[7] In addition to fluctuations in BP, beneficial effects on residual renal function might account for the inhibition of increases in PWV in the patients on PD, because deterioration of residual renal function induces greater fluctuations in the circulating levels of toxic substances such as angiotensin II. In the present study, the residual renal function of patients on PD was well preserved as compared with that in the patients on HD at one year after the initiation of dialysis therapy. Similar observations have been reported elsewhere.[8],[9],[10] Our study has some limitations. The number of patients was too small to predict the effects of PWV on the mortality rate in patients on HD and PD.

Conflict of interest: None declared.



 
   References Top

1.
Suzuki T, Kanno Y, Nakamoto H, Okada H, Sugahara S, Suzuki H. Peritoneal dialysis versus hemodialysis: A five-year comparison of survival and effects on the cardiovascular system, erythropoiesis, and calcium metabolism. Adv Perit Dial 2003;19:148-54.  Back to cited text no. 1
    
2.
Nakai S, Shinzato T, Nagura Y, et al. An overview of regular dialysis treatment in Japan (as of 31 December 2001). Ther Apher Dial 2004;8:3-32.  Back to cited text no. 2
    
3.
United States; Department of Health and Human Services; Centers for Medicare and Medicaid Services. 2003 annual report: ESRD clinical performance measures project. Am J Kidney Dis 2004;44 2 Suppl 1:A5-6, S1-92.  Back to cited text no. 3
    
4.
Covic A, Goldsmith DJ, Florea L, Gusbeth- Tatomir P, Covic M. The influence of dialytic modality on arterial stiffness, pulse wave reflections, and vasomotor function. Perit Dial Int 2004;24:365-72.  Back to cited text no. 4
    
5.
Suzuki H, Nakamoto H, Okada H, Sugahara S. Correlations between changes (D) in pulse wave velocity (PWV) and differences in systolic blood pressure (BP) predialysis and post dialysis (p <0.05). Mimura et al.145.  Back to cited text no. 5
    
6.
Takenaka T, Kobayashi K, Suzuki H. Pulse wave velocity as an indicator of arteriosclerosis in hemodialysis patients. Atherosclerosis 2004;176:405-9.  Back to cited text no. 6
    
7.
Konings CJ, Dammers R, Rensma PL, et al. Arterial wall properties in patients with renal failure. Am J Kidney Dis 2002;39:1206-12.  Back to cited text no. 7
    
8.
Heaf JG, Løkkegaard H, Madsen M. Initial survival advantage of peritoneal dialysis relative to haemodialysis. Nephrol Dial Transplant 2002;17:112-7.  Back to cited text no. 8
    
9.
Jansen MA, Hart AA, Korevaar JC, et al. Predictors of the rate of decline of residual renal function in incident dialysis patients. Kidney Int 2002;62:1046-53.  Back to cited text no. 9
    
10.
Pecoits-Filho R, Heimbürger O, Bárány P, et al. Associations between circulating inflammatory markers and residual renal function in CRF patients. Am J Kidney Dis 2003;41:1212-8.  Back to cited text no. 10
    

Top
Correspondence Address:
Sana Barrah
Department of Nephrology, Dialysis and Transplantation, La Rabta Hospital, Tunis
Tunisia
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DOI: 10.4103/1319-2442.335444

PMID: 35017326

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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    Abstract
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