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Abstract: FR-PO721

New Approach for Assessing Vascular Stiffness in Patients with Hemodialysis

Session Information

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Shin, Dong Ho, College of Medicine, Hallym University, Seoul, Korea (the Republic of)
  • Kim, Do Hyoung, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea (the Republic of)
  • Noh, Jung-woo, Hallym University, Seoul, Korea (the Republic of)
  • Han, Chaehoon, kangnam secred heart hospital, Seoul, Korea (the Republic of)
Background

It is known that increased vascular stiffness, as measured by pulse wave velocity (PWV), can predict cardiovascular events in hemodialysis (HD) patients. Additionally, the measurement of static intra-access pressure ratio (SIAPR), using transducer on HD machines, is preferred vascular access surveillance method. However, little is known about the clinical usefulness of SIAPR in predicting the degree of vascular stiffness.

Methods

A total of 209 patients on maintenance hemodialysis were evaluated between January 2014 and February 2018 at three hospitals. Brachial-ankle pulse wave velocity (baPWV) and SIAPR were measured in HD patients. After that, we performed echocardiography at study enrollment and investigated cardiovascular (CV) events after study enrollment, respectively.

Results

Patients with arteriovenous (AV) graft and AV fistula was 172 and 37, respectively. Among AV fistula group, SIAPR was significantly negative correlation with baPWV (ß = - 0.16, p =0.04). The area under the receiver operating (ROC) curve for SIAPR value to predict CV events was 0.09 (95% confidence interval [CI]; 0.86 - 0.95, p < 0.001). A SIAPR value of 0.09 was selected as the cut-off value for CV events. baPWV (222.7 ± 418.1 vs. 2010.2 ± 511.4 cm/s, P = 0.04) and the proportion of left ventricular diastolic dysfunction (86% vs. 25%, p = 0.01) was significantly higher in patients with a SIAPR value ≤ 0.09 than with a SIAPR value > 0.09. Kaplan-Meier analysis revealed that cumulative incidence of CV events was significant higher in patients with a SIAPR value ≤ 0.09 (p.= 0.04). Among AV graft group, there were significantly negative correlation between SIAPR and baPWV. When a SIAPR value of 0.15 was selected as the cut-off value for CV events, similar trends were observed.

Conclusion

SIAPR was significantly associated with baPWV and left ventricular diastolic dysfunction in HD patients. Additionally, lower value of SIAPR could predict cardiovascular events.