What is the clinical evidence from this study?

Study design: Observational. Population: End-stage renal disease on hemodialysis (n=89). Intervention: Hemodialysis vs. Pre-hemodialysis baseline. Primary outcome: Right brachial-ankle pulse wave velocity (baPWV) in cm/s (p=<0.001).

January 1, 2007Open Access

Influence of Different Measurement Time Points on Brachial-Ankle Pulse Wave Velocity and Ankle-Brachial Index in Hemodialysis Patients

Q: What are the key findings of this study?

Hemodialysis acutely increased right brachial-ankle pulse wave velocity from 1801 to 1946 cm/s (p<0.001), which returned to pre-dialysis levels on the next dialysis-free day, while ankle-brachial index remained constant.

Resultado clave

Hemodialysis acutely increased right brachial-ankle pulse wave velocity from 1801 to 1946 cm/s (p<0.001), which returned to pre-dialysis levels on the next dialysis-free day, while ankle-brachial index remained constant.

Diseño del estudio

Tipo

Observational (n=89)

Multicéntrico

Sí

PICO estructurado

Does the timing of measurement relative to hemodialysis affect brachial-ankle pulse wave velocity and ankle-brachial index in hemodialysis patients?

Población

89 patients undergoing regular hemodialysis, with a mean age of 56 years, evaluated for changes in arterial stiffness markers before, after, and on the day following hemodialysis.

Exposición

Hemodialysis (routine HD 3 times a week for 3-4 hours)

Resultado

Changes in brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI) measured 10-30 min before HD, 10-30 min after HD, and 22±2 h after HD (next dialysis-free day)surrogate

When evaluating arterial stiffness using baPWV in hemodialysis patients, the measurement time relative to the dialysis session is essential as baPWV transiently increases after dialysis, whereas ABI remains constant and can be measured at any time.

Resultado numérico

Tasa de eventos absoluta: 1946% vs 1801%

valor p: p=<0.001

Limitaciones

Changes of preload and afterload were determined indirectly by changes in body weight and systolic BP, not by invasive data.
Did not check the values of atherosclerotic markers to determine which are responsible for the increase in baPWV after HD.
An analysis of reproducibility was not performed in this study.

Resumen

In order to ensure that they are reliable markers of atherosclerosis and suitable for repetitive follow-up of disease progression and management responses in hemodialysis (HD) patients, brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI) should be tested to see whether they change with different measurement time points. The aim of this study was to assess whether baPWV and ABI vary according to whether they are measured before HD, after HD, or on the next dialysis-free day. Eighty-nine patients undergoing regular HD were enrolled. The baPWV and ABI were measured 10-30 min before and after HD, and if patients agreed, on the next dialysis-free day. The third measurement of baPWV and ABI, performed 22+/-2 h after HD, was taken in 72 patients (81%). The body weight reduction after HD was 2.5+/-0.9 kg (por=0.498). In conclusion, despite the significant decrease in body weight and blood pressures, baPWV increased significantly after HD. In addition, baPWV, but not ABI, may vary at different measurement time points. Therefore, baPWV, but not ABI, should be assessed in a timely manner in HD patients.

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