Solofra, Italy
Solofra, Italy

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Di Micco L.,SOC di Nefrologia | Torraca S.,SOC di Nefrologia | Sirico M.L.,SOC di Nefrologia | Tartaglia D.,SOC di Nefrologia | Di Iorio B.,SOC di Nefrologia
Hypertension Research | Year: 2012

Pulse wave velocity (PWV) is a predictor of morbidity and mortality in patients with end-stage renal disease (ESRD). Dialysis patients show cyclic changes in PWV related to their hydration status and blood pressure. Our aim is to assess the impact of daily dialysis on PWV. We performed a randomized crossover study of 60 patients who underwent standard hemodialysis (HD) three times per week for at least 6 months. Patients were classified into three groups according to their PWV values before (pre-) and after (post-) HD, with a cutoff value of 12 m s -1, as follows: the low-low (LL) group had normal pre-HD and post-HD PWV; the high-low (HL) group had high pre-HD PWV and normal post-HD PWV; and the high-high (HH) group had high pre-and post-HD PWV. All patients continued standard HD for 2 weeks. A total of 10 patients from each group were randomly assigned to continue standard HD for 1 week and then underwent daily dialysis for 1 week. The remaining 10 patients underwent daily dialysis for 1 week and then underwent standard HD for 1 week. PWV values were measured before and 1 h after each dialysis session. With daily dialysis treatment, 2 of 20 patients (10%) moved from the PWV-HH group to the PWV-HL group, whereas 18 of 20 patients (90%) moved from the PWV-HL group to the PWV-LL group (P=0.030). Daily dialysis reduces PWV in the ESRD patients. As PWV is a strong predictor of mortality in ESRD and has cyclic variations in patients who are on standard HD, we believe that daily dialysis may be used in patients with high PWV levels to reduce their mortality risk. © 2012 The Japanese Society of Hypertension All rights reserved.

Torraca S.,SOC di Nefrologia | Sirico M.L.,SOC di Nefrologia | Guastaferro P.,SOC di Nefrologia | Morrone L.F.,SOC di Nefrologia | And 6 more authors.
Hemodialysis International | Year: 2011

We have already demonstrated that in chronic hemodialysis (HD) patients, the cyclic variations in both hydration status and blood pressure are responsible for changes in pulse wave velocity (PWV). The aim of this study is to verify whether the cyclic variation of PWV influences mortality in dialysis patients. We studied 167 oligoanuric (urinary output <500mL/day) patients on chronic standard bicarbonate HD for at least 6 months. They performed 3 HD sessions of 4 hours per week. Patients were classified into 3 groups: normal PWV before and after dialysis (LL); high PWV before and normal PWV after dialysis (HL); and high PWV before and after dialysis (HH). The carotid-femoral PWV was measured with an automated system using the foot-to-foot method. Analysis of variance was used to compare the different groups. The outcome event studied was all-cause mortality and cardiovascular mortality. The PWV values observed were LL in 44 patients (26.3%); HL in 53 patients (31.8%); and HH in 70 patients (41.9%). The 3 groups of patients are homogenous for sex, age, and blood pressure. The HH group had a higher prevalence of (P<0.001) ASCVD. It is interesting that the distribution of patients in the 3 groups is correlated with the basal value of PWV. In fact, when the basal measure of PWV is elevated, there is a higher probability that an HD session cannot reduce PWV (<12ms). A total of 53 patients (31.7%) died during the follow-up of 2 years: 5 patients in the LL group (11.4%); 16 in the HL group (30.2%); and 32 in the HH group (50.7%) (LL vs. HL, P=0.047; LL vs. HH, P<0.00001; HL vs. HH, P=0.034). We evidence for the first time that different behaviors of PWV in dialysis subjects determine differences in mortality. © 2011 The Authors. Hemodialysis International © 2011 International Society for Hemodialysis.

PubMed | SOC di Nefrologia
Type: Journal Article | Journal: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association | Year: 2010

The major determinants of pulse wave velocity (PWV) in haemodialysis (HD) patients are not fully known. We studied chronic HD patients to assess the effect of cyclic variations in both hydration status and blood pressure on PWV.Twenty patients were examined along three consecutive HD sessions and interdialysis periods during a week-long period. Twenty healthy subjects and 20 chronic kidney disease (CKD) patients (stage 5) were evaluated as controls.In contrast to controls, HD patients showed cyclic changes in PWV. Specifically, PWV values in HD patients were significantly higher prior to the first HD session of the week compared with values measured prior to the other two HD sessions during the week. In addition, PWV showed significant reductions during each dialysis session (15.6 +/- 5.2 to 9.3 +/- 2.3, 13.4 +/- 4.0 to 8.7 +/- 2.4, and 12.4 +/- 2.6 to 9.2 +/- 2.2 m/sec, before and after the first, second and third weekly dialysis sessions, respectively). Nevertheless, the weighted weekly values of PWV in HD patients (10.8 +/- 5.7 m/sec) were similar to those in CKD patients (9.9 +/- 4.2 m/sec). The HD ultrafiltration rate (UF) was significantly correlated with intradialysis PWV changes (r = 0.465; P < 0.001) and with after dialysis PWV values (r = -0.654; P < 0.0001). Blood pressure changes during dialysis were weakly correlated with post-dialysis PWV (r = -0.267; P < 0.05), but not with PWV changes during dialysis.In chronic HD patients, single PWV values varied widely during 1 week of HD sessions, whereas the weighted level showed only a slight increase. The major determinant of changes in PWV during HD appears to be the alterations in hydration status; the most representative time point for PWV measurements during HD corresponds to the interdialysis days.

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