Document Detail


Arterial stiffness and interdialytic weight gain influence ambulatory blood pressure patterns in hemodialysis patients.
MedLine Citation:
PMID:  18160623     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Besides an overall increase in blood pressure, hemodialysis patients have marked disturbance in interdialytic ambulatory blood pressure pattern that is characterized by blunted circadian amplitude and a steady rise in blood pressure between dialysis treatments. The pathophysiology of this abnormal blood pressure profile is poorly understood. We hypothesized that the circadian amplitude, the interdialytic increase (linear trend), and the average level of blood pressure (the intercept) are related to the extent of arterial stiffening and the degree of accumulation of salt and water between dialysis treatments. Using a generalized cosinor model, we simultaneously compared the impact of interdialytic weight gain and echo-Doppler-measured aortic pulse wave velocity on the mean level of blood pressure, linear changes over the interdialytic interval, and oscillatory changes in blood pressure. In a cross-sectional analysis of 11,833 blood pressure measurements from 125 long-term hemodialysis patients, we found that aortic pulse wave velocity and interdialytic weight gain had a substantial impact on interdialytic ambulatory blood pressure level, trends, and rhythms. Arterial stiffness was associated with an overall increase in the level (intercept) of systolic, diastolic, and pulse pressure. Interdialytic weight gain, on the other hand, was associated with interdialytic increase (linear trend) in blood pressure. The circadian amplitude was blunted by increments in either arterial stiffness or interdialytic weight gain. Since patterns of ambulatory arterial blood pressure are related to cardiovascular risk factors such as interdialytic weight gain and increased arterial stiffness, the pattern of ambulatory blood pressure recordings may also be of prognostic significance in hemodialysis patients.
Authors:
Rajiv Agarwal; Robert P Light
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2007-12-26
Journal Detail:
Title:  American journal of physiology. Renal physiology     Volume:  294     ISSN:  1931-857X     ISO Abbreviation:  Am. J. Physiol. Renal Physiol.     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-01-30     Completed Date:  2008-04-24     Revised Date:  2011-04-28    
Medline Journal Info:
Nlm Unique ID:  100901990     Medline TA:  Am J Physiol Renal Physiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  F303-8     Citation Subset:  IM    
Affiliation:
Division of Nephrology, Department of Medicine, Indiana University School of Medicine, and Richard L. Roudebush Department of Veterans Affairs Medical Center, Indianapolis, Indiana 46202, USA. ragarwal@iupui.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aorta, Thoracic / physiopathology
Arteries / physiopathology*
Blood Flow Velocity / physiology
Blood Pressure / physiology*
Blood Pressure Monitoring, Ambulatory
Circadian Rhythm / physiology
Echocardiography, Doppler
Female
Humans
Kidney Failure, Chronic / physiopathology,  therapy
Male
Middle Aged
Models, Biological
Renal Dialysis*
Weight Gain / physiology*
Grant Support
ID/Acronym/Agency:
5R01-DK-062030-05/DK/NIDDK NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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