The effects of duration of hemodialysis on the parameters of central and peripheral hemodynamics in patients with end-stage renal disease

Aim

To assess the effect of duration of treatment with hemodialysis (HD) on parameters of peripheral and central hemodynamics during the 44-h intradialytic period.

Material and methods

We performed 44-h ambulatory blood pressure monitoring (ABPM) during the interdialytic period in 68 adults with end-stage renal disease (ESRD) on maintenance HD. Blood pressure (BP) was measured in the brachial artery and aorta using a validated oscillometric device and was analyzed according to the HD duration: 3 to 48 months, 49 to 84 months or more than 84 months.

Results

A longer treatment with HD was associated with an increase in peripheral 44-h systolic BP (SBP) (140 [123;142]; 146 [133;160], 150 [138;161] mm Hg, respectively; p<0.05 for a trend) and central 44-h SBP (123 [114;131]; 132 [119;146]; 139 [128;149] mm Hg; p<0.05). Peripheral 44-h diastolic BP (DBP) did not depend on the duration of HD, while the central DBP increased with a longer HD duration. Patients with the short duration of HD (3 to 48 months) had the lowest peripheral and central pulse BP. BP increased from Day 1 to Day 2 of intradialytic period in patients with HD duration of >84 months: peripheral SBP increased from 145 [133;157] to 156 [143;169] mm Hg (p<0.05), peripheral DBP increased from 82 [76;88] to 85 [79;92] mm Hg (p<0.05), and central SBP increased from 136 [124; 147] to 143 [131; 156] mm Hg (p<0.05).

Conclusion

In patients with ESRD, a longer duration of treatment with HD was associated with an increase in the peripheral and central SBP (44-h, for Day 1 to Day 2 of intradialytic days 1 and 2) and central DBP. The greatest increase of BP from the first to the second intradialytic day was observed in patients with duration of treatment of more than 84 months.

Key words

End-stage renal disease (ESRD), hemodialysis, arterial hypertension, ABPM, central blood pressure.