Noninvasive evaluation of large artery function and structure in dialysis patients: Clinical applications

Non-invasive evaluation of large artery function and structure may improve cardiovascular risk stratification.Specific treatments in renal failure can affect arterial function/structure.For example, in peritoneal dialysis, a dialysis fluid exchange causes acute central hemodynamic effects due to the instilled volume, and in hemodialyzed patients, anemia has a flow-independent negative impact on endothelial function that can be corrected by erythopoietin administration.Arterial calcification is a common feature in renal failure.In a multicentre European study of 1084 dialysis patients abdominal aortic calcification (AAC) was scored from a plain lateral abdominal radiograph.AAC increased significantly from L1 to L4 and was related to carotid-femoral pulse wave velocity (PWV), independent of age, blood pressure and diabetes.Nevertheless, AAC scores and PWV provided complementary predictive information for cardiovascular events and mortality at 2 years follow-up.Non-invasive assessment of central hemodynamic parameters and endothelial function can be useful to unravel pathophysiologic mechanisms in heterogeneous populations such as dialysis patients.Semi-quantitative AAC scoring and assessment of PWV are inexpensive, fast and reliable methods that can be implemented in routine daily clinical practice to improve cardiovascular risk stratification in renal patients.Nutritional 25-OH Vitamin D 3 (25(OH)D 3 ) deficiency may be a link between bone and vascular disease in uremia.In a study of 52 hemodialysis patients, low 25(OH)D 3 levels were independently related to increased PWV and reduced brachial artery distensibility, and therefore, among the many factors involved in arterial stiffness and vascular calcification, nutritional Vitamin D deficiency may be the cheapest and safest to correct.

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