Effects of hemodialysis on blood volume, macro- and microvascular function.
Microvasc Res
; 129: 103958, 2020 05.
Article
em En
| MEDLINE
| ID: mdl-31734376
ABSTRACT
BACKGROUND:
Vascular dysfunction is considered to spur the progression of cardiovascular disease in hemodialysis (HD) patients. Whether the HD procedure itself contributes to vascular dysfunction remains incompletely investigated. The present study sought to comprehensively assess the effects of HD on arterial and venous function along with concomitant changes in blood volume (BV). METHODS ANDRESULTS:
We determined BV with high-precision, automated carbon monoxide-rebreathing, arterial stiffness using applanation tonometry and intrinsic microvascular function via retinal vessel analysis prior to and after conventional 4-hour HD in fasting-controlled conditions in 10 patients. All HD patients were non-smokers and non-obese (body mass indexâ¯=â¯22.8⯱â¯2.8â¯m·kg-2). Hypertension (70%), coronary artery disease (40%) and diabetes mellitus (20%) were the most prevalent comorbidities. Prior to HD, all patients presented with hypervolemia (+2208⯱â¯1213â¯ml). HD decreased body weight (-1.72⯱â¯1.25â¯kg, Pâ¯=â¯0.002) and plasma volume (-689⯱â¯566â¯ml, Pâ¯=â¯0.004), while hematocrit (Hct) was concomitantly increased (+4.8⯱â¯4.5%, Pâ¯=â¯0.009). HD did not affect large elastic artery stiffness, as determined by carotid-femoral pulse wave velocity (Pâ¯=â¯0.448) and carotid distensibility (Pâ¯=â¯0.562). In contrast, flicker light-induced retinal venular dilation was reduced by three-fourths after HD (-2.4⯱â¯1.7%, Pâ¯=â¯0.039), in parallel to increased retinal venular diameter (+11.2⯱â¯4.9⯵m, Pâ¯=â¯0.002). In regression analyses, a negative association was observed between HD-induced changes in Hct and retinal venular dilation (râ¯≥â¯-0.89, Pâ¯≤â¯0.045).CONCLUSION:
Conventional HD resulting in substantial plasma volume removal do not alter large artery elastic properties, whereas intrinsic microvascular venular dilator function is markedly impaired, an effect directly associated with the increase in hemoconcentration.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Tipo de estudo:
Diagnostic_studies
Limite:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article