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Hypervolemia rather than arterial calcification and extracoronary atherosclerosis is the main determinant of pulse pressure in hemodialysis patients

  • Nephrology – Original Paper
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Abstract

Introduction

Pulse pressure (PP) has been reported as an independent predictor of cardiovascular mortality in hemodialysis patients. In this study, we aimed to investigate association of PP with echocardiographic and vascular structural changes such as atherosclerosis and arterial calcifications in HD patients.

Patients and methods

In this cross-sectional study, 108 chronic hemodialysis patients (49 male, 59 female, mean age: 46 ± 13 years) were included. Biochemical analyses, echocardiographic and high-resolution carotid Doppler examinations were done. Aortic wall and coronary artery calcifications were measured with electron beam computed tomography. The degree of carotid artery stenosis was measured at four different sites (communis, bulbus, interna and externa) in both carotid arteries.

Results

PP was strongly correlated with systolic (r: 0.82) and diastolic (r: 0.33) blood pressure, left ventricular mass index (r: 0.58), left ventricle end diastolic diameter (r: 0.38) and weakly correlated with aortic wall calcification score (r: 0.26) and carotid plaque score (r: 0.27), but not with coronary artery calcification score. Patients with carotid plaque had higher PP than patients without plaque (50 ± 16 mmHg versus 44 ± 14 mmHg, P = 0.05). Patients were divided into three groups according to aortic wall calcification score. PP was significantly higher in patients with higher aortic wall calcification (54 ± 16 mmHg) than patients with lower aortic wall calcification (44 ± 15 mmHg, P = 0.04). However, on multivariate linear regression analysis for predicting PP, the only significant factor retained was left ventricle end diastolic diameter.

Conclusion

PP was weakly associated with large vessel calcification and atherosclerosis in hemodialysis patients. The bulk of the effect on PP seems to be due to hypervolemia.

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Acknowledgments

This study was supported by Turkish Kidney Foundation with grant number 415-A/2009. Authors would like to thank to our dialysis nurses for their kind helps in data collection. All EBCT measurements were performed in TEST Radiology Center.

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Authors and Affiliations

  1. Division of Nephrology, Department of Internal Medicine, Istanbul School of Medicine, Istanbul University, Capa, Topkapi, Istanbul

    Halil Yazici & Alaattin Yildiz

  2. Department of Cardiology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey

    Huseyin Oflaz

  3. Department of Internal Medicine, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey

    Hamdi Pusuroglu & Vakur Akkaya

  4. TEST Radiology Center, Istanbul, Turkey

    Savas Tepe

  5. Fresenius Medical Care, Istanbul, Turkey

    Cengiz Dogan & Ali Basci

Authors
  1. Halil Yazici
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  2. Huseyin Oflaz
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  3. Hamdi Pusuroglu
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  4. Savas Tepe
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  5. Cengiz Dogan
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  6. Ali Basci
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  8. Alaattin Yildiz
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Correspondence to Alaattin Yildiz.

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Yazici, H., Oflaz, H., Pusuroglu, H. et al. Hypervolemia rather than arterial calcification and extracoronary atherosclerosis is the main determinant of pulse pressure in hemodialysis patients. Int Urol Nephrol 44, 1203–1210 (2012). https://doi.org/10.1007/s11255-011-0024-9

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  • DOI: https://doi.org/10.1007/s11255-011-0024-9

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