Assessment of the 24-hour profle of blood pressure and arterial stiffness in patients with end-stage renal disease

Objective. The purpose of our study was to research specifc features the daily changes of the vascular stiffness (VS) in patients with end-stage renal disease (ESRD) and to assess the feasibility of using the 24-hour vascular index Pulse Time Index of Norm (PTIN) (the percentage of the 24-hour period during which the pulse wave velocity (PWVao) does not exceed 10 m/second) in the management of arterial hypertension (HTN) in patients after renal transplantation (RT).

Design and methods. We examined 158 people, divided into 4 comparable age groups: those receiving program hemodialysis (PGD), patients after RT, patients with essential HTN and healthy volunteers. All of them underwent 24-hour blood pressure (BP) monitoring with a daily evaluation of VS indices and central BP. At follow-up, 27 patients from the PG group underwent all assessments also 1 week and 6 months after transplantation.

Results. Patients with ESRD compared with patients with essential HTN had elevated PWVao, night central BP and decrease PTIN. PTIN changes were the most signifcant. In 27 patients a week after the RT a decrease in the PTIN was found in most cases. After 6 months the mean PTIN in the whole group increased again. Our study demonstrates HTN persistence after kidney transplantation can be predicted. Two PTIN states could be predicted by the cutoff PTIN value that was determined in the study: a state of improvement and a state of decline/unchanged state. PTIN cutoff value at 45 % was characterized by 69 % sensitivity, 76 % specifcity and AUC of 0,65. Therefore, baseline PTIN ≥ 45 % (before RT) is associated with its further growth, and a favourable course of HTN.

Conclusions. Patients receiving replacement therapy, compared to patients with essential HTN, showed a marked increase in the daily VS and the night central BP. The daily PTIN is the most accurate predictor of the changes in the VS index, the PTIN values before the RT at the PG stage allow predicting the course of HTN after the RT

1. Nikolaev AYu, Milovanov YuS. Treatment of renal failure. 2nd ed. Moscow: OOO MIA; 2011. In Russian.

2. Asmar R, Benetos A, Topouchian J, Laurent P, Pannier B, Brisac AM et al. Assessment of arterial distensibility by automatic pulse wave velocity measurement. Validation and clinical application studies. Hypertension. 1995;26(3):485–490.

3. Cardiovascular prevention. National guidelines of Russian Scientifc Society of Cardiology. Cardiovascular Therapy and Prevention. 2011; 10(6), Annex 2. In Russian.

4. Posokhov IN. Pulse wave velocity 24-hour monitoring with one-site measurements by oscillometry. Med Devices (Auckl). 2013; 6:11–15.

5. Кобалава Ж.Д., Котовская Ю.В., Моисеев В.С. Артериальная гипертония. Ключи кдиагностике илечению.М.: ГЭОТАРМедиа, 2009.

6. Lindner A, Charra B, Sherrard DJ, Scribner BH. Accelerated atherosclerosis in prolonged maintenance hemodialysis. N Engl J Med. 1974;290(13):697–701.

7. Blacher J, Guerin AP, Pannier B, Marchais SJ, London GM. Arterial calcifcations, arterial stiffness, and cardiovascular risk in end-stage renal disease. Hypertension. 2001;38(4):938–942.

8. Covic A, Goldsmith D, Gusbeth-Tatomir P, Buhaescu I, Covic M. Successful renal transplantation decreases aortic stiffness and increases vascular reactivity in dialysis patients. Transplantation. 2003;76(11):1573–1577.

9. Bachelet-Rousseau C, Kearney-Schwartz A, Frimat L, Fay R, Kessler M, Benetos A. Evolution of arterial stiffness after kidney transplantation. Nephrol Dial Transplant. 2011;26 (10):3386–3391.

10. Gaborieau V, Delarche N, Gosse P. Ambulatory blood pressure monitoring vs self-measurement of blood pressure at home: correlation with target organ damage. J Hypertens. 2008;26 (10):1919–1927.

11. Sugawara J, Hayashi K, Yokoi T, Tanaka H. Carotidfemoral pulse wave velocity: impact of different arterial path length measurements. Artery Res. 2010;4(1):27–31.

12. Barenbrock M, Hausberg M, Kosch M, Kisters K, Hoeks AP, Rahn KH. Effect of hyperparathyroidism on arterial distensibility in renal transplant recipients. Kidney Hit. 1998;54 (1):210–215.

13. Vergoulas G, Miserlis G, Karasavvidou F, Imvrios G, Katsara I, Georgilas N et al. The blood pressure after renal transplantation. A single center experience. Hippokratia. 2002;6 (2):62–70.