Charalampos Loutradis1, Aikaterini Papagianni1, Robert Ekart2, Marieta Theodorakopoulou1, Ioanna Minopoulou1, Efstathios Pagourelias3, Stella Douma4, Asterios Karagiannis5, Francesca Mallamaci6, Carmine Zoccali6, Gerard London7, Pantelis A Sarafidis8. 1. Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. 2. Department of Nephrology, University Clinical Centre Maribor, Maribor, Slovenia. 3. 3rd Department of Cardiology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. 4. 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. 5. 2nd Propaedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. 6. CNR-IFC Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy. 7. Hospital and FCRIN INI-CRCTC, Manhes, France. 8. Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. psarafidis11@yahoo.gr.
Abstract
BACKGROUND:Arterial stiffness is a strong predictor of death and cardiovascular (CV) events in hemodialysis patients. Only few studies tested interventions aiming to improve arterial stiffness in this population. This study examines the effect of dry-weight reduction with a standardized lung-ultrasound-guided strategy on ambulatory aortic blood pressure (BP) and arterial stiffness parameters in hemodialysis. METHODS:Seventy-one clinically euvolemic hemodialysis patients with hypertension, were included in this single-blind randomized clinical-trial. Patients were randomized in the active group (n = 35), following dry-weight reduction guided by the total number of US-B lines before a mid-week dialysis session and the control group (n = 36), following standard treatment. Patients underwent office evaluation of arterial stiffness and 48-h ABPM to capture ambulatory central systolic (cSBP) and diastolic BP (cDBP) and arterial stiffness indexes at baseline and after 8-weeks. RESULTS: US-B lines decreased in the active and slightly increased in the control group (p < 0.001) during follow-up. Office-pulse-wave-velocity (PWV) decreased from baseline to study-end only in the active group, resulting in significant between-group differences (- 0.25 ± 0.71 vs 0.20 ± 1.18 m/s p = 0.037). Reduction in 48-h-cSBP (- 6.30 ± 8.90 vs - 0.50 ± 12.46; p = 0.027) was greater and in cDBP (- 3.85 ± 6.61 vs - 0.63 ± 8.36; p = 0.077) marginally greater in the active compared to control group. 48-h-central-pulse-pressure (cPP, 41.51 ± 9.63 vs 39.06 ± 9.61 mmHg; p = 0.004) and 48-h-PWV (9.30 ± 2.00 vs 9.08 ± 2.04 m/s p = 0.032) were significantly reduced during follow-up in the active group and were unchanged in controls, resulting in significant between-group differences. In contrast, 48-h-AIx and AIx(75) were not different between the two groups. CONCLUSION:Lung-ultrasound-guided dry-weight reduction decreased ambulatory aortic-BP and ambulatory or office-PWV, but not ambulatory-AIx(75). These results suggest that dry-weight reduction is an important treatment approach to improve these cardiovascular risk factors in hemodialysis.
RCT Entities:
BACKGROUND: Arterial stiffness is a strong predictor of death and cardiovascular (CV) events in hemodialysis patients. Only few studies tested interventions aiming to improve arterial stiffness in this population. This study examines the effect of dry-weight reduction with a standardized lung-ultrasound-guided strategy on ambulatory aortic blood pressure (BP) and arterial stiffness parameters in hemodialysis. METHODS: Seventy-one clinically euvolemic hemodialysis patients with hypertension, were included in this single-blind randomized clinical-trial. Patients were randomized in the active group (n = 35), following dry-weight reduction guided by the total number of US-B lines before a mid-week dialysis session and the control group (n = 36), following standard treatment. Patients underwent office evaluation of arterial stiffness and 48-h ABPM to capture ambulatory central systolic (cSBP) and diastolic BP (cDBP) and arterial stiffness indexes at baseline and after 8-weeks. RESULTS: US-B lines decreased in the active and slightly increased in the control group (p < 0.001) during follow-up. Office-pulse-wave-velocity (PWV) decreased from baseline to study-end only in the active group, resulting in significant between-group differences (- 0.25 ± 0.71 vs 0.20 ± 1.18 m/s p = 0.037). Reduction in 48-h-cSBP (- 6.30 ± 8.90 vs - 0.50 ± 12.46; p = 0.027) was greater and in cDBP (- 3.85 ± 6.61 vs - 0.63 ± 8.36; p = 0.077) marginally greater in the active compared to control group. 48-h-central-pulse-pressure (cPP, 41.51 ± 9.63 vs 39.06 ± 9.61 mmHg; p = 0.004) and 48-h-PWV (9.30 ± 2.00 vs 9.08 ± 2.04 m/s p = 0.032) were significantly reduced during follow-up in the active group and were unchanged in controls, resulting in significant between-group differences. In contrast, 48-h-AIx and AIx(75) were not different between the two groups. CONCLUSION: Lung-ultrasound-guided dry-weight reduction decreased ambulatory aortic-BP and ambulatory or office-PWV, but not ambulatory-AIx(75). These results suggest that dry-weight reduction is an important treatment approach to improve these cardiovascular risk factors in hemodialysis.
Authors: Rajiv Saran; Bruce Robinson; Kevin C Abbott; Lawrence Y C Agodoa; Jennifer Bragg-Gresham; Rajesh Balkrishnan; Nicole Bhave; Xue Dietrich; Zhechen Ding; Paul W Eggers; Abduzhappar Gaipov; Daniel Gillen; Debbie Gipson; Haoyu Gu; Paula Guro; Diana Haggerty; Yun Han; Kevin He; William Herman; Michael Heung; Richard A Hirth; Jui-Ting Hsiung; David Hutton; Aya Inoue; Steven J Jacobsen; Yan Jin; Kamyar Kalantar-Zadeh; Alissa Kapke; Carola-Ellen Kleine; Csaba P Kovesdy; William Krueter; Vivian Kurtz; Yiting Li; Sai Liu; Maria V Marroquin; Keith McCullough; Miklos Z Molnar; Zubin Modi; Maria Montez-Rath; Hamid Moradi; Hal Morgenstern; Purna Mukhopadhyay; Brahmajee Nallamothu; Danh V Nguyen; Keith C Norris; Ann M O'Hare; Yoshitsugu Obi; Christina Park; Jeffrey Pearson; Ronald Pisoni; Praveen K Potukuchi; Kaitlyn Repeck; Connie M Rhee; Douglas E Schaubel; Jillian Schrager; David T Selewski; Ruth Shamraj; Sally F Shaw; Jiaxiao M Shi; Monica Shieu; John J Sim; Melissa Soohoo; Diane Steffick; Elani Streja; Keiichi Sumida; Manjula Kurella Tamura; Anca Tilea; Megan Turf; Dongyu Wang; Wenjing Weng; Kenneth J Woodside; April Wyncott; Jie Xiang; Xin Xin; Maggie Yin; Amy S You; Xiaosong Zhang; Hui Zhou; Vahakn Shahinian Journal: Am J Kidney Dis Date: 2019-02-21 Impact factor: 8.860