Introduction: It remains unclear why the optimal haemoglobin target is lower in patients with chronic kidney disease (CKD) than in non-CKD persons. Arteriosclerosis and consequent impaired arterial function comprise a central cardiovascular risk mechanism in CKD. We hypothesized that the optimal haemoglobin target depends on its opposing effects on arterial stiffness and pressure pulsatility in CKD.
Methods: Arterial stiffness (aortic pulse wave velocity), wave reflection (augmentation index, reflected wave pressure and reflection magnitude), and pressure pulsatility (central systolic and pulse pressure, peripheral pulse pressure, pressure amplification and forward wave pressure) were assessed in 48 dialysis patients.
Results: In established confounder and diabetes adjusted linear regression models, haemoglobin levels were directly associated with arterial stiffness (partial R=0.366, p=0.03) and inversely with central systolic pressure (partial R=-0.344, p=0.04), central pulse pressure (partial R=-0.403, p=0.01), peripheral pulse pressure (partial R=-0.521, p=0.001) and forward wave pressure (partial R=-0.544, p=0.001). The presence of heart failure and use of angiotensin converting enzyme inhibitors or angiotensin receptor blockers and erythropoietin stimulating agents did not materially alter these relationships upon further adjustment for the respective characteristics in the models, and in sensitivity analyses. In receiver operator characteristic curve analysis, the optimal haemoglobin concentration cut-off values in predicting arterial stiffness and increased central pulse pressure were remarkably similar at 10.95 g/dl and 10.85 g/dl, respectively, and with clinically useful sensitivities, specificities and positive and negative predictive values. In logistic regression models, a haemoglobin value of >10.9 mg/dl was associated with both arterial stiffness (>10 m/sec; OR (95% CI) = 10.48 (1.57-70.08), p=0.02) and normal central pulse pressure (>50 mmHg; OR (95% CI) = 7.55 (1.58-36.03), p=0.01).
Conclusion: This study suggests that the optimal haemoglobin target in dialysis patients is ~11g/dl and determined by its differential and contrasting effects on arterial stiffness and pressure pulsatility.
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http://dx.doi.org/10.2147/IJNRD.S285168 | DOI Listing |
J Magn Reson Imaging
January 2025
Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Background: Central arterial stiffening is associated with brain white matter (WM) damage and gray matter (GM) volume loss in older adults, but little is known about this association from an adult lifespan perspective.
Purpose: To investigate the associations of central arterial stiffness with WM microstructural organization, WM lesion load, cortical thickness, and GM volume in healthy adults across the lifespan.
Study Type: This is a cross-sectional study.
J Hypertens
December 2024
Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea.
Background: People with diabetes often have increased blood pressure (BP) variability because of autonomic dysfunction and arterial stiffness, making it a critical factor in predicting clinical outcomes. We investigated the reproducibility of long-term visit-to-visit BP variability (VVV) and the minimum number of BP readings to reliably determine VVV in people with diabetes.
Methods: This multicenter retrospective study used data from electronic health records of the Korea University Medical Center database.
J Hypertens
December 2024
Division of Internal Medicine, Candiolo Cancer Institutute FPO - IRCCS, Candiolo.
Background: Heart failure with preserved ejection fraction (HFpEF) is a high prevalence condition, with high rates of hospitalization and mortality. Arterial hypertension is the main risk factor for HFpEF. Among hypertensive patients, alterations in cardiac and vascular morphology identify hypertension-mediated organ damage (HMOD).
View Article and Find Full Text PDFJ Hypertens
December 2024
Department of Ultrasound Medicine, Tangdu Hospital, Air Force Medical University.
Background: The arterial stiffening is attributed to the intrinsic structural stiffening and/or load-dependent stiffening by increased blood pressure (BP). The respective lifetime alterations and major determinants of the two components with normal aging are not clear.
Methods: A total of 3053 healthy adults (1922 women) aged 18-79 years were enrolled.
Am J Hypertens
January 2025
HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone, Zambia.
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