Análisis comparativo de la rigidez arterial evaluada en forma no invasiva en pacientes hemodializados / Comparative analysis of arterial stiffnes non invasively evaluated in hemodialyzed patients

INTRODUCCIÓN: Los cambios de la rigidez arterial de pacientes hemodializados se producen en vasos elásticos y musculares pero sólo la Velocidad de la Onda del Pulso (VOP) aórtica ha demostrado ser un índice de alto valor pronóstico. Lo cual deja de lado a las arterias musculares. OBJETIVOS: Los objetivos del estudio fueron: a) medir la VOP aórtica y la carotido-radial de pacientes hemodializados, y b) repetir el análisis anterior en la misma cohorte 5 años después, comparando cuatro índices diferentes de rigidez arterial. MATERIAL Y MÉTODOS: A 23 pacientes hemodializados se les evaluó la VOP aórtica (VOPcf), la carotido-radial (VOPcr) y se calculó: la VOP centro-periférica (VOPcp), la diferencia (ΔVOP), el desacople de VOP y su cambio porcentual (%VOP). Las evaluaciones se hicieron en 2007 (Tiempo 1) y en 2012 (Tiempo 2). RESULTADOS: La VOPcp mostró un aumento significativo entre la evaluación realizada entre el Tiempo 1 y el 2 (de 1.1±0.3 a 1.4±0.4; p<0.01). En los mismos tiempos ΔVOP mostró que los valores se incrementaban en términos negativos (de -0.9±3.0 a -2.7±2.9; p<0.05). El desacople de la rigidez centro-periférica mostró un significativo aumento (valores negativos) entre el Tiempo 1 y 2 (de 0.0±0.1 a -0.1±0.1; p<0.02). El %VOP entre ambas mediciones (valores negativos) mostró un significativo aumento (de -4.8±22.0 a -21.5±24.2; p<0.05). CONCLUSIONES: En la presente investigación los índices de rigidez obtenidos en pacientes hemodializados, incluyendo arterias tanto elásticas y musculares, mostraron diferencias estadísticamente significativas cuando se compararon dos mediciones separadas por cinco años. Sin embargo los niveles de significación no fueron similares

OBJECTIVES: Changes in arterial stiffness in hemodialysis patients occur both, in elastic and muscular vessels but only the aortic Pulse Wave Velocity (PWV) has demonstrated to be a high prognostic value index, however, muscular arteries are not involved in the aortic PWV measurement. The purpose of this research was: a) to evaluate the aortic and carotid-radial PWV of hemodialysis patients, b) to repeat these measurements in the same cohort after 5 years comparing four different arterial stiffness indexes. METHODS: 23 hemodialyzed patients carotid-femoral PWV (PWVcf) and carotid-radial (PWVcr) were evaluated and calculations were as follows: PWV ratio, PWV difference (/PWV), PWV mismatch and PWV percentage change (%PWV). These evaluations were performed using data obtained in 2007 (Time 1) and 2012 (Time 2). RESULTS: PWV ratio showed a significant increase between measurements performed in Time 1 and 2 (from 1.1±0.3 to 1.4±0.4; p≤0.01). Similar increases in negative terms were found when /PWV was calculated from -0.9±3.0 to -2.7±2.9; p≤0.05) Calculated values of PWV mismatch increased significantly (negative values) between Time 1 and 2 (from 0.0±0.1 to -0.1±0.1; p≤0.02) Percent changes of PWV between Time 1 and 2 (negative values) showed a significant increase (from -4.8±22.0 to -21.5±24.2; p≤0.05). CONCLUSIONS: Stiffness indexes, obtained in hemodialyzed patients including both elastic and muscular arteries used in this research showed statistically significant differences when two measures with 5 years interval were compared. However significance levels were not similar

Prevalence of impaired fasting glycemia, impaired glucose tolerance, and type 2 diabetes in hemodialyzed patients when applying new diagnostic criteria.

OBJECTIVE: Recently, the American Diabetes Association (ADA) proposed a new diagnostic entity for diabetes mellitus that has not been applied in renal failure patients so far. Our goal was to apply the new impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) criteria in a group of hemodialyzed patients to provide data on glucose alterations in chronic renal failure. DESIGN AND PATIENTS: We evaluated 74 hemodialyzed patients, (38 women, 36 men) without diagnosed diabetes. Blood was collected at fasting and at 120 minutes after a 75-g glucose intake, and insulin levels were determined. The weight, height, waist circumference, and hip circumference of each patient were measured, and the body mass index (BMI) and waist-hip ratio were calculated. RESULTS AND CONCLUSION: Values of fasting plasma glycemia and 120-minute oral glucose tolerance test were (mean +/- SD) 78 +/- 9.4 mg/dL and 121 +/- 39 mg/dL, respectively. Among the 74 subjects studied, 5 patients had IFG, none of them showing a glucose level above 110 mg/dL. If the ADA 1997 criteria were applied, these patients would be classified as normal. On the other hand, 15 of the 74 patients showed IGT, this prevalence being higher compared with that of the general population. Finally, in 5 of the 74 patients the presence of type 2 diabetes was shown by the second test. According to sex, no differences were observed in the prevalence of IFG, IGT, or diabetes. Glucose alterations are characteristics that need to be identified in chronic renal failure patients. Our results suggests that the glucose tolerance test might be evaluated during hemodialysis treatment to define its prevalence.