Autori: M Palladino (1), V Calvez (2), G Punzo (1), P Menè (1), M Ciavarella (2), C Savoia (2), C Fofi (1)
Affiliazioni: (1)Dipartimento di Medicina Clinica e Molecolare, Sapienza Università di Roma, UOC Nefrologia, AO Sant’Andrea, Roma; (2)Dipartimento di Medicina Clinica e Molecolare, Sapienza Università di Roma, UOC Cardiologia, AO Sant’Andrea, Roma
Objective
Uremia induces vascular stiffness through several mechanisms. We sought to determine the role of dialytic vintage (DV) on the indexes of structural alterations in the cardiovascular system.
Design and method
We studied 14 patients in chronic hemodialysis. Twenty-four newly diagnosed never treated hypertensive patients and 16 normotensive controls were also studied.
The patients on hemodialysis were divided in two groups with respect to the DV: <60-months (DV<60,n=7) or >60-months (DV>60,n=7). In each patient were evaluated retrospectively the following parameters: calcium/phosphate levels, uric acid, arterial hypertension, BMI, ultrafiltration volume. After dialysis, with dry weight reached in all patients, we evaluated peripheral blood pressure (pBP), the parameters derived by tonometric analysis of the pulse waveform (central blood pressure-cBP-, Subendocardial Viability Ratio-SEVR-, pulse-wave-velocity-PWV-) and those derived from ecocardiocolorDoppler: ejection fraction (EF-for systolic function) and E/e’ (for diastolic function).
Results
All the groups were similar for sex and BMI, both DV<60 and DV>60 were older than the newly diagnosed hypertensive patients and controls (58.33±3.71 and 59.83±7.98 vs 44.14±1.28 and 40.63±2.05 years, respectively,P<0.05). In both DV<60 and DV>60 calcium/phosphate levels and ultrafiltration volume were similar pBP was significantly increased and similar to hypertensive patients in DV>60 vs DV<60 (systolic-pBP: 154.2±4.51mmHg vs 132.5±5.18mmHg,P<0.01 and diastolic-pBP:90.4±49mmHg vs 78.5±3.3mmHg,P<0.01). cBP was increased and similar to hypertensive patients in DV>60 vs DV<60 (systolic-cBP: 140.8±8.4mmHg vs 111.2±3.36 mmHg,P<0.001 and diastolic-cBP: 88.2±3.73mmHg vs 72.33±7.78mmHg, respectively,P<0.05). PWV was similar in normotensive, hypertensives and DV<60, whereas it was increased only in DV>60 vs the other groups (9.6±1.4m/s vs 6.19±0.28m/s and 7.03±0.22m/s and 7.13±1.4m/s, respectively,p<0.05). SEVR was similar in all the groups. EF was preserved and similar in all the groups. E/e’ was significantly increased in both groups on dialysis vs hypertensives and normotensives, however E/e’ was significantly higher in DV>60 vs DV<60 (9.16±1.14 vs 6.96±0.72,P<0.01).
Conclusions
Only patients with DV>60 presented increased aortic stiffness and diastolic dysfunction independently of other parameters. This was associated to higher peripheral BP. Hence chronic hemodialytic treatment, particularly after 60 months, may play a putative role for the development of cardiovascular alterations in patients with end-stage renal disease.
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