Prognostic value of arterial rigidity parameters in the development of intradialysis hypertension

Arterial rigidity plays a significant role in the occurrence of cardiovascular pathology in hemodialysis patients (HD). At the same time, its contribution to the development of specific intradialysis cardiovascular complications remains poorly understood.

The aim of the study is to clarify the prognostic value of arterial rigidity parameters in the development of intradialysis hypertension (IDH) in software-based HD patients.

Material and methods. The prospective study included 45 software-based HD patients. The IDG criterion was an increase in systolic blood pressure >10 mmHg after the HD procedure in more than 4 out of 6 sessions in the period preceding the daily blood pressure monitoring (DBPM). Arterial rigidity was assessed by means of the device using the Vasotens-24 bp lab software package (Peter Telegin, Nizhny Novgorod, Russia). Demographic data of patients and objective examination data, laboratory indicators, dialysis experience, concomitant cardiovascular diseases, and drug therapy were also recorded. The analysis of the obtained data was performed using the IBM SPSS Statistics 26.

 Software package application. The average age of patients was 51 [41; 61], dialysis experience was 4.5 [1.1; 7.8]. IDH occurred in 20 dialysis patients and, according to multivariate correlation analysis, was associated with the patient’s age (relative risk (HR) 3.78; 95% confidence interval (CI) 1.29–11.04) and such an indicator of arterial rigidity as the augmentation indexAIx (OR 7.75; 95% CI 2.65–22.7). An inverse correlation was observed between the development of IDH and the time ofpropagation of the reflected wave-RWTT_100-60  (OR 0.27; 95% CI 0.14–0.53), the presence of diabetic nephropathy (OR 0.34; 95% CI 0.094–1.251), residual diuresis (OR 0.43; 95% CI 0.21–0.87) and the level of albumin (OR 0.12; 95% CI 0.02–0.79). At the same time, the inclusion of arterial rigidity parameters in the mathematical model increased its predictive ability from AUC 0.886 to AUC 0.978.

 Conclusion. In this study, values of AIx ≥ -6.5% and RWTT _100-60 ≤ 134.5 m/s were associated with a higher frequency of IDH, which may indicate a leading role of progressive arterial rigidity in the development of intradialysis cardiovascular  complications.

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