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(Hypertension. 2003;42:257.)
© 2003 American Heart Association, Inc.

Scientific Contributions

Volume Status and Blood Pressure During Long-Term Hemodialysis

Role of Ventricular Stiffness

Chen-Huan Chen; Yao-Ping Lin; Wen-Chung Yu; Wu-Chang Yang; Yu-An Ding

From the Department of Medicine, Taipei Veterans General Hospital, and the Department of Social Medicine, National Yang-Ming University, Taipei, Taiwan.

Reprint requests to Chen-Huan Chen, MD, 201 Shih-Pai Rd, Sec 2, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. E-mail chench{at}vghtpe.gov.tw

The importance of volume status on blood pressure in hemodialysis patients has long been recognized. We hypothesized that the enhanced volume dependency of blood pressure is partly determined by ventricular stiffness at end systole. A total of 115 long-term hemodialysis patients were invited to receive a comprehensive, noninvasive cardiovascular examination. End-systolic elastance was determined by using a novel, noninvasive echo-Doppler technique. The positive ratios of the interdialytic systolic blood pressure change vs weight gain during the subsequent 25 hemodialysis sessions were averaged to obtain the volume sensitivity index (mm Hg/kg). The averaged interdialytic weight gain per fat-free mass was correlated significantly with averaged percent change in systolic blood pressure (r=0.45, P<0.001). The estimated end-systolic elastance at baseline was significantly correlated with subsequently observed volume sensitivity index (volume sensitivity index=[1.17xend-systolic elastance]+6.4; r=0.34, P=0.001). End-systolic elastance was also significantly correlated with various vascular function parameters, including effective arterial elastance (r=0.48, P<0.001), pulse wave velocity (r=0.30, P=0.001), carotid augmentation index (r=0.31, P<0.001), and aortic compliance (r=-0.49, P<0.001). The results suggest that end-systolic elastance, a direct measure of left ventricular mechanical properties at end systole, is coupled to arterial mechanical properties and predicts the extent of subsequent interdialytic systolic blood pressure rise relative to weight gain. Therefore, ventricular stiffness at end systole is a determinant of the enhanced volume sensitivity of blood pressure in hemodialysis patients.

Key Words: renal dialysis • hypertension, renovascular • blood pressure • blood volume • arteriosclerosis • cardiac function