Aortic Pulse Wave Velocity as a Biomarker in Chronic Dialysis Patients

Avramovski, Petar and Sikole, Aleksandar (2016) Aortic Pulse Wave Velocity as a Biomarker in Chronic Dialysis Patients. In: BIOMARKERS IN KIDNEY DISEASE. Springer Nature, England, Springer Nature, pp. 1-23. ISBN 978-0-12-803014-1

Text (Book Chapter in Biomarkers in Kidney Disease) 3. (2016) SPRINGERbook chapter, Aortic PWV as a biomarker in CHP.pdf - Published Version Download (546kB)

Abstract

Abstract
Cardiovascular mortality is considered the main cause of death in patients
receiving dialysis and is 10–20 times higher in such patients than in the general
population. A high percentage of all cardiovascular mortality diseases are
associated with stiffening of the arteries, a direct consequence of atherosclerosis.
Increased central arterial stiffening is a hallmark of the aging process and
consequence of many disease states, such as diabetes, atherosclerosis, and
chronic renal compromise. Accelerated arteriosclerosis is a major risk to longterm
survivors on maintenance hemodialysis.
Measuring of the pulse wave velocity provides useful information regarding
the mechanical properties of the arterial tree and can be used to assess the stiffness
and endothelial function. From all the different methods to assess arterial stiffness,
carotid to femoral pulse wave velocity has emerged as the gold standard
method. Two Doppler waves are recorded transcutaneously at the base of the neck
for the right common carotid artery and over the right common femoral artery.
After that, the Doppler waves are identified and their time delay diversity is
measured simultaneously with electrocardiography. Time delay (transition time,
ΔT) is the time from the R wave to the foot of the carotid or femoral Doppler
waveform.
There is a high prevalence of increased pulse wave velocity in a relatively
young hemodialysis patient population. Vascular stiffening likely begins much
earlier and progresses more rapidly in hemodialysis patients. Accelerated arteriosclerosis
is a major risk to long-term survivors on maintenance hemodialysis. The
pulse wave velocity measured at baseline was markedly higher in chronic hemodialysis
patients than in general population patients, with a greater than twofold
higher annual increase. In the general population group, only factors associated
with the progression of arterial stiffness in the elderly were evident (traditional
risk factors), but in chronic kidney disease patients, arterial stiffness (i.e. pulse
wave velocity) is accelerated due to synergism between age and traditional risk
factors plus factors related to renal comorbidity (nontraditional risk factors).
Patients with end stage renal disease face a particularly high risk of cardiovascular
disease and total mortality. It is now known that pulse wave velocity, C-reactive
protein and serum albumin are strongly and independently predictive of outcome
in chronic hemodialysis patients. Whether enhanced arterial stiffness is a risk
factor contributing to the development of cardiovascular disease or a marker of
established cardiovascular disease is a matter of debate. The pulse wave velocity
is a strong independent predictor of over-all and cardiovascular mortality with
high-level performance values, assessed by simple, indirect, reproducible and
noninvasive evaluation of regional arterial stiffness.
Keywords
Pulse wave velocity • Stiffness • Clinical biomarker • Chronic dialysis • Doppler •
Cardiovascular mortality • Traditional risks factors • Nontraditional risk factors

Item Type:	Book Section
Subjects:	Scientific Fields (Frascati) > Medical and Health Sciences > Clinical medicine
Divisions:	UKLO Network
Depositing User:	D-r Petar Avramovski
Date Deposited:	27 May 2024 06:03
Last Modified:	27 May 2024 06:03
URI:	https://eprints.uklo.edu.mk/id/eprint/9904

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