Abstract
The mean arterial pressure (MAP) usually serves as an expression of blood pressure in patients on chronic haemodialysis (PCHD), instead of using solely systolic or diastolic pressure. Pulse pressure (PP) has been recognized as an important correlate of mortality in PCHD. We conducted this study in order to demonstrate clinical and biochemical determinants and variability of predialysis and postdialysis MAP and PP values. A total of 136 single haemodialysis (HD) treatments in 23 subjects (PCHD, 11 male and 12 female patients) were processed during 15 months. MAP before HD was in negative correlation with haemoglobin (P<0.001) and body mass index (BMI) (P<0.001), and in positive correlation with weekly erythropoietin dosage (P=0.017). MAP after HD was in negative correlation with haemoglobin (P<0.001), ultrafiltration per HD (P=0.015), and BMI (P=0.001), and in positive correlation with weekly erythropoietin dosage (P=0.003). PP before HD was in negative correlation with parathyroid hormone (PTH) level (P=0.020), haemoglobin (P<0.001), ultrafiltration per HD (P=0.001), and years on the chronic HD treatment (P=0.001), and in positive correlation with weekly erythropoietin dosage (P<0.001) and age (P<0.001). PP after HD was in significant negative correlation with PTH (P=0.015), haemoglobin (P=0.005), ultrafiltration per HD (P<0.001), BMI (P=0.003), and in positive correlation with weekly erythropoietin dosage (P<0.001) and age (P=0.004). Multiple regression analyses unveiled the strongest and negative correlations between MAP before HD and BMI (β=−0.37, P=0.01); MAP after HD and haemoglobin (β=−0.36, P=0.01); PP after HD and ultrafiltration/body weight ratio (β=−0.41, P<0.001). The strongest and positive correlation was found between PP before HD and erythropoietin dosage per week (β=0.51, P<0.001). In conclusion, our findings support the assumption that PP and MAP are associated with different clinical parameters. PP values have advantages as the method of blood pressure expression.
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References
Locatelli F et al. Cardiovascular disease determinants in chronic renal failure: clinical approach and treatment. Nephrol Dial Transplant 2001; 16: 459–468.
Rahman M, Smith MC . Hypertension in hemodialysis patients. Curr Hypertens Rep 2001; 3: 496–502.
Scribner BH . Chronic renal disease and hypertension. Dial Transplant 1998; 27: 702–704.
Fleischmann EH, Bower JD, Salahudeen AK . Risk factor paradox in hemodialysis: better nutrition as a partial explanation. ASAIO J 2001; 47: 74–81.
Zager PG et al. ‘U’ curve association of blood pressure and mortality in hemodialysis patients. Kidney Int 1998; 54: 561–569.
Horl MP, Horl WH . Hemodialysis-associated hypertension: pathophysiology and therapy. Am J Kidney Dis 2002; 39: 227–244.
Franklin SS et al. The importance of pulsatile components of hypertension in predicting carotid stenosis in older adults. J Hypertens 1997; 15: 1143–1150.
Klassen PS et al. Association between pulse pressure and mortality in patients undergoing maintenance hemodialysis. JAMA 2002; 287: 1548–1555.
Abdelfatah AB, Motte G, Ducloux D, Chalopin JM . Determinants of mean arterial pressure and pulse pressure in chronic haemodialysis patients. J Hum Hypertens 2001; 15: 775–779.
Daugirdas JT . Second generation logarithmic estimates of single-pool variable volume Kt/V: an analysis of error. J Am Soc Nephrol 1993; 4 (5): 1205–1213.
Depner TA, Daugirdas JT . Equations for normalized protein catabolic rate based on two-point modeling of hemodialysis urea kinetics. J Am Soc Nephrol 1996; 7: 780–785.
Friedewald WT, Levy RJ, Fredrickson DS . Estimation of the concentration of low density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972; 18: 499–502.
Hanes DS, Weir MR, Sowers JR . Gender considerations in hypertension pathophysiology and treatment. Am J Med 1996; 101: 10–21.
Rocco MV et al. HEMO Study Group. Risk factors for hypertension in chronic hemodialysis patients: baseline data from the HEMO study. Am J Nephrol 2001; 21: 280–288.
Amann K, Rychlik I, Miltenberger-Milteny G, Ritz E . Left ventricular hypertrophy in renal failure. Kidney Int Suppl 1998; 54: 78–85.
Kusano E et al. Effect of ticlopidine hydrochloride on erythropoietin-induced rise in blood pressure in patients on maintenance hemodialysis. Nephron 2002; 91: 654–658.
Santoro A, Mancini E . Cardiac effects of chronic inflammation in dialysis patients. Nephrol Dial Transplant 2002; 17: 10–15.
Stenvinkel P, Alvestrand A . Inflammation in end-stage renal disease: sources, consequences, and therapy. Semin Dial 2002; 15: 329–337.
Maiorca R et al. Morbidity and mortality of CAPD and hemodialysis. Kidney Int Suppl 1993; 40: 4–15.
Level C et al. Determinants of arterial compliance in patients treated by hemodialysis. Clin Nephrol 2001; 56: 435–444.
Galarza CR et al. Diastolic pressure underestimates age-related hemodynamic impairment. Hypertension 1997; 30: 809–816.
Timio M . Cardiotoxicity of parathyroid hormone in chronic renal failure. Ital J Miner Electrolyte Metab 1995; 9: 119–124.
Goldsmith DJ, Covic A, Sambrooke PA, Ackrill P . Vascular calcification in long-term haemodialysis patients in a single unit: a retrospective analysis. Nephron 1997; 77: 37–43.
Block GA, Hulbert-Shearon TE, Levin NW, Port FK . Association of serum phosphorus and calcium × phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis 1998; 31: 607–617.
Zucchelli P, Santoro A . Dry weight in hemodialysis: volemic control. Semin Nephrol 2001; 21: 286–290.
Fishbane S, Natke E, Maesaka JK . Role of volume overload in dialysis-refractory hypertension. Am J Kidney Dis 1996; 28: 257–261.
Prakash S et al. Central, peripheral, and other blood volume changes during hemodialysis. ASAIO J 2002; 48: 379–382.
Ozkahya M et al. Treatment of hypertension in dialysis patients by ultrafiltration: role of cardiac dilatation and time factor. Am J Kidney Dis 1999; 34: 218–221.
Testa A, Plou A . Clinical determinants of interdialytic weight gain. J Ren Nutr 2001; 11: 155–160.
Luik AJ et al. Effects of hypervolemia on interdialytic hemodynamics and blood pressure control in hemodialysis patients. Am J Kidney Dis 1997; 30: 466–474.
Erkan E, Devarajan P, Kaskel F . Role of nitric oxide, endothelin-1, and inflammatory cytokines in blood pressure regulation in hemodialysis patients. Am J Kidney Dis 2002; 40: 76–81.
Raj DS et al. Hemodynamic changes during hemodialysis: role of nitric oxide and endothelin. Kidney Int 2002; 61: 697–704.
Locatelli F, Manzoni C, Marcelli D . Treatment of hypertension in chronic renal insufficienc. J Nephrol 1997; 10: 220–223.
Argiles A, Mourad G, Mion C . Seasonal changes in blood pressure in patients with end-stage renal disease treated with hemodialysis. N Engl J Med 1998; 339: 1364–1370.
Winnicki M et al. Relation of 24-hour ambulatory blood pressure and short-term blood pressure variability to seasonal changes in environmental temperature in stage I hypertensive subjects. Results of the harvest trial. Clin Exp Hypertens 1996; 18: 995–1012.
Agarwal R, Lewis RR . Prediction of hypertension in chronic hemodialysis patients. Kidney Int 2001; 60: 1982–1989.
Mitra S, Chandna SM, Farrington K . What is hypertension in chronic haemodialysis? The role of interdialytic blood pressure monitoring. Nephrol Dial Transplant 1999; 14: 2915–2921.
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Kovacic, V., Roguljic, L., Kovacic, V. et al. Mean arterial pressure and pulse pressure are associated with different clinical parameters in chronic haemodialysis patients. J Hum Hypertens 17, 353–360 (2003). https://doi.org/10.1038/sj.jhh.1001557
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DOI: https://doi.org/10.1038/sj.jhh.1001557