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Abstract: FR-PO351

A Systematic Review of Interventions Targeting Arterial Stiffness in ESRD

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Rodriguez, Rosendo A., Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
  • Hae, Richard, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
  • Spence, Matthew, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
  • Shea, Beverley J., Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
  • Agharazii, Mohsen, CHUQ-HDQ, Quebec City, Quebec, Canada
  • Burns, Kevin D., Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
Background

Increased carotid-femoral pulse wave velocity (cf-PWV) in end-stage renal disease (ESRD) patients is indicative of both increased arterial stiffness and high risk for cardiovascular and overall mortality. Several strategies have been studied to decrease arterial stiffness in ESRD, using cf-PWV as a monitoring tool. We conducted a systematic review to explore the effect of these interventions on cf-PWV in ESRD patients.

Methods

MEDLINE, EMBASE and EBM databases were searched for all randomised and observational studies that evaluated interventions to improve arterial stiffness in adults with ESRD. The primary outcome was a reduction of cf-PWV and secondarily, the effects on blood pressure (BP). Study screening, selection, data collection and assessment of methodological quality were performed by two independent reviewers. Study-level effect estimates and pooled estimates were provided by computing the mean differences (MD) and 95% confidence intervals (CI) using the DerSimonian and Laird method and the random effects model.

Results

From 6,607 citations identified, 68 studies met eligibility criteria (randomised: 29; observational studies: 39), and 33 studies were suitable for meta-analysis of 7 interventions (Table). Bio-electrical impedance-guided ultrafiltration (UF), low calcium dialysate, intra-dialytic exercise and calcium channel blockers (CCB) effectively reduced cf-PWV, but only UF and CCB decreased BP compared to standard care. Cholecalciferol or cinacalcet did not affect cf-PWV or BP. Kidney transplantation decreased BP but not cf-PWV compared to dialysis.

Conclusion

Bio-impedance guided UF, low calcium dialysate, exercise and CCB reduce arterial stiffness in ESRD patients. The effectiveness of combining these strategies in decreasing adverse cardiovascular events in ESRD patients requires further study in randomised clinical trials.

Funding

  • Government Support - Non-U.S.