Key result
Hemodialysis was initially associated with higher excess pressure integral (OR 2.39; 95% CI 1.16-4.98), but this association was driven by the presence of an arteriovenous fistula (P=0.008).
Why the study?
The excess pressure integral (XSPI) is linked to adverse clinical outcomes, but its determinants and potential associations with dialysis modality and arteriovenous fistula presence were unexamined.
Is hemodialysis or the presence of an arteriovenous fistula associated with increased excess pressure integral in dialysis patients?
Cross-Sectional (n=290)
Is hemodialysis or the presence of an arteriovenous fistula associated with increased excess pressure integral in dialysis patients?
Higher excess pressure integral in hemodialysis patients appears to be driven by the presence of an arteriovenous fistula rather than the dialysis modality itself.
BACKGROUND: Arterial reservoir-wave analysis (RWA)-a new model of arterial hemodynamics-separates arterial wave into reservoir pressure (RP) and excess pressure (XSP). The XSP integral (XSPI) has been associated with increased risk of clinical outcomes. The objectives of the present study were to examine the determinants of XSPI in a mixed cohort of hemodialysis (HD) and peritoneal dialysis (PD) patients, to examine whether dialysis modality and the presence of an arteriovenous fistula (AVF) are associated with increased XSPI. METHOD: In a cross-sectional study, 290 subjects (232 HD and 130 with AVF) underwent carotid artery tonometry (calibrated with brachial diastolic and mean blood pressure). The XSPI was calculated through RWA using pressure-only algorithms. Logistic regression was used for determinants of XSPI above median. Through forward conditional linear regression, we examined whether treatment by HD or the presence of AVF is associated with higher XSPI. RESULTS: Patients with XSPI above median were older, had a higher prevalence of diabetes and cardiovascular disease, had a higher body mass index, and were more likely to be on HD. After adjustment for confounders, HD was associated with a higher risk of higher XSPI (odds ratio = 2.39, 95% confidence interval: 1.16-4.98). In a forward conditional linear regression analysis, HD was associated with higher XSPI (standardized coefficient: 0.126, P = 0.012), but on incorporation of AVF into the model, AVF was associated with higher XSPI (standardized coefficient: 0.130, P = 0.008) and HD was excluded as a predictor. CONCLUSION: This study suggests that higher XSPI in HD patients is related to the presence of AVF.
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Paré et al. (2019) conducted a cross-sectional in End-stage renal disease requiring dialysis (n=290). Hemodialysis and Arteriovenous fistula vs. Peritoneal dialysis and no arteriovenous fistula was evaluated on Excess pressure integral (XSPI) above median (OR 2.39, 95% CI 1.16-4.98). Hemodialysis was initially associated with higher excess pressure integral (OR 2.39; 95% CI 1.16-4.98), but this association was driven by the presence of an arteriovenous fistula (P=0.008).
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