Clinical Investigation

Kidney International (1990) 37, 137–142; doi:10.1038/ki.1990.19

Aortic and large artery compliance in end-stage renal failure

Gerard M London1, Sylvain J Marchais1, Michel E Safar1, Albert F Genest1, Alain P Guerin1, Fabien Metivier1, Khalil Chedid1 and Alena M London1

1Centre Hospitalier Manhes, Fleury Merogis and Centre de Diagnostic, Hôpital Broussais, Paris, France

Correspondence: Dr G M London, Centre Hospitalier Manhes, 91700 Fleury Merogis, France.

Received 9 January 1989; Revised 25 May 1989; Accepted 18 July 1989.

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Abstract

Aortic and large artery compliance in end-stage renal failure. Pulse wave velocity (PWV) was measured in the aorta, right leg and arm of 90 control subjects (CS) and 92 hemodialysis patients (HD) of the same age and mean arterial pressure (MAP). Blood chemistry, including blood lipids, and echographic dimensions of the aorta, were measured in all subjects. Presence of aortic calcification was evaluated by abdominal X-ray and echography. Whereas femoral and brachial PWV were only slightly increased in HD (P < 0.05), the aortic PWV was significantly elevated (1113 plusminus 319 cm/sec) in comparison with CS (965 plusminus 216 cm/sec; P = 0.0016). Aortic diameters were larger in HD, both at the root of aorta (32.7 plusminus 4 vs. 28.2 plusminus 2.8 mm; P < 0.0001) and aortic bifurcation (16.9 plusminus 3.1 vs. 14.6 plusminus 2.2 mm; P < 0.0001). Although the MAP was similar in HD (109.9 plusminus 19.3 mm Hg) and CS (110.2 plusminus 17.2 mm Hg), the pulse pressure was significantly increased in HD patients (76.6 plusminus 23.7 vs. 63.9 plusminus 22 mm Hg; P = 0.007). In the two populations, aortic PWV was found to increase with age (P < 0.0001) and MAP (P < 0.0001). The presence of aortic calcification showed only a borderline relationship with the increase in aortic PWV (P = 0.050 in CS and P = 0.069 in HD). As change in PWV is directly related to change in distensibility, and the aortic diameters were increased in HD, these results indicate that aortic wall compliance is decreased in HD, resulting in an increase in the pulsatile component of arterial pressure. Alteration of pulsatile arterial dynamics contributes to an increase in left ventricular load and is significantly related to the left ventricular hypertrophy which is frequently observed in these patients (P < 0.001).

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