Introduction: Unfavorable changes in cardiac and arterial function are related to poor prognosis in chronic kidney disease (CKD). We compared hemodynamic profiles between subjects with end-stage renal disease and 2 control groups with corresponding pulse wave velocities (PWVs). Methods: Noninvasive hemodynamics were recorded during passive head-up tilt in CKD stage 5 patients (n = 35), patients with primary hypertension (n = 35, n = 30 with antihypertensive medications), and subjects without cardiovascular or renal diseases and cardiovascular medications (n = 70). The groups were selected to have corresponding age, sex, body mass index, and PWV. Hemodynamic data were captured using whole-body impedance cardiography and radial tonometric pulse wave analysis. Results: Supine blood pressure did not differ between the groups, but upright diastolic blood pressure was lower in CKD patients than in the 2 control groups (p ≤ 0.001 for both, RANOVA). Despite similar PWV, supine aortic pulse pressure was higher in CKD patients versus nonmedicated subjects (p = 0.029). Two additional measures indicated reduced aortic compliance in CKD patients versus both control groups: lower ratio of stroke index to aortic pulse pressure (p ≤ 0.023) and higher aortic characteristic impedance (p ≤ 0.003). The subendocardial viability ratio was lower in the CKD group than in both control groups (p ≤ 0.039). Conclusion: In the absence of differences in PWV, higher aortic pulse pressure and characteristic impedance, and lower ratio of stroke index to aortic pulse pressure, suggest reduced aortic compliance and impaired left ventricular function in CKD patients. A lower subendocardial viability ratio predisposes the CKD patients to impaired cardiac oxygen supply versus hypertensive patients and nonmedicated controls.

1.
Baumann
M
,
Wassertheurer
S
,
Suttmann
Y
,
Burkhardt
K
,
Heemann
U
.
Aortic pulse wave velocity predicts mortality in chronic kidney disease stages 2–4
.
J Hypertens
.
2014 Apr
;
32
(
4
):
899
903
.
2.
Blacher
J
,
Guerin
AP
,
Pannier
B
,
Marchais
SJ
,
Safar
ME
,
London
GM
.
Impact of aortic stiffness on survival in end-stage renal disease
.
Circulation
.
1999 May
;
99
(
18
):
2434
9
.
3.
Tripepi
G
,
Agharazii
M
,
Pannier
B
,
D’Arrigo
G
,
Mallamaci
F
,
Zoccali
C
,
Pulse wave velocity and prognosis in end-stage kidney disease
.
Hypertension
.
2018 Jun
;
71
(
6
):
1126
32
.
4.
Foley
RN
,
Parfrey
PS
,
Sarnak
MJ
.
Clinical epidemiology of cardiovascular disease in chronic renal disease
.
Am J Kidney Dis
.
1998 Nov
;
32
(
5
):
S112
9
.
5.
de Jager
DJ
,
Grootendorst
DC
,
Jager
KJ
,
van Dijk
PC
,
Tomas
LM
,
Ansell
D
,
Cardiovascular and noncardiovascular mortality among patients starting dialysis
.
JAMA
.
2009 Oct
;
302
(
16
):
1782
9
.
6.
Cozzolino
M
,
Mangano
M
,
Stucchi
A
,
Ciceri
P
,
Conte
F
,
Galassi
A
.
Cardiovascular disease in dialysis patients
.
Nephrol Dial Transplant
.
2018 Oct
;
33
(
Suppl 3
):
iii28
34
.
7.
Townsend
RR
,
Wimmer
NJ
,
Chirinos
JA
,
Parsa
A
,
Weir
M
,
Perumal
K
,
Aortic PWV in chronic kidney disease: a CRIC ancillary study
.
Am J Hypertens
.
2010 Mar
;
23
(
3
):
282
9
.
8.
Kim
ED
,
Tanaka
H
,
Ballew
SH
,
Sang
Y
,
Heiss
G
,
Coresh
J
,
Associations between kidney disease measures and regional pulse wave velocity in a large community-based cohort: the atherosclerosis risk in communities (ARIC) study
.
Am J Kidney Dis
.
2018 Jul
;
72
(
5
):
682
90
. .
9.
Tholen
S
,
Klofat
K
,
Pan
CR
,
Schmaderer
C
,
Lutz
J
,
Heemann
U
,
Progression of aortic pulse wave velocity in patients with chronic kidney disease
.
J Clin Hypertens
.
2013
;
15
(
11
):
833
8
. .
10.
Kong
X
,
Ma
X
,
Tang
L
,
Wang
Z
,
Li
W
,
Cui
M
,
Arterial stiffness evaluated by carotid-femoral pulse wave velocity increases the risk of chronic kidney disease in a Chinese population-based cohort
.
Nephrology
.
2017 Mar
;
22
(
3
):
205
12
.
11.
Chue
CD
,
Edwards
NC
,
Davis
LJ
,
Steeds
RP
,
Townend
JN
,
Ferro
CJ
.
Serum phosphate but not pulse wave velocity predicts decline in renal function in patients with early chronic kidney disease
.
Nephrol Dial Transplant
.
2011 Aug
;
26
(
8
):
2576
82
.
12.
Sedaghat
S
,
Mattace-Raso
FU
,
Hoorn
EJ
,
Uitterlinden
AG
,
Hofman
A
,
Ikram
MA
,
Arterial stiffness and decline in kidney function
.
Clin J Am Soc Nephrol
.
2015 Dec
;
10
(
12
):
2190
7
. .
13.
Ford
ML
,
Tomlinson
LA
,
Chapman
TP
,
Rajkumar
C
,
Holt
SG
.
Aortic stiffness is independently associated with rate of renal function decline in chronic kidney disease stages 3 and 4
.
Hypertension
.
2010 May
;
55
(
5
):
1110
5
. .
14.
Jia
L
,
Zhang
W
,
Ma
J
,
Chen
X
,
Chen
L
,
Li
Z
,
Pulse pressure, instead of brachium-ankle pulse wave velocity, is associated with reduced kidney function in a Chinese Han population
.
Kidney Blood Press Res
.
2017
;
42
(
1
):
43
51
.
15.
Xu
T
,
Xie
J
,
Zong
X
,
Wang
W
,
Ren
H
,
Chen
N
.
Pulse wave velocity: a valuable predictor for cardio-cerebrovascular disease and death in PD patients
.
Blood Purif
.
2015
;
40
(
3
):
203
8
.
16.
Radzi
AB
,
Kasim
SS
.
Pulse wave velocity in assessing arterial stiffness in patients with mild-to-moderate renal impairment
.
J Hypertens
.
2019 Jul
;
37
:
e285
. .
17.
El Ghoul
B
,
Daaboul
Y
,
Korjian
S
,
El Alam
A
,
Mansour
A
,
Hariri
E
,
Etiology of end-stage renal disease and arterial stiffness among hemodialysis patients
.
BioMed Res Int
.
2017 Feb
;
2017
:
2543262
. .
18.
Cerasola
G
,
Nardi
E
,
Palermo
A
,
Mulè
G
,
Cottone
S
.
Epidemiology and pathophysiology of left ventricular abnormalities in chronic kidney disease: a review
.
J Nephrol
.
2011 Feb
;
24
(
1
):
1
10
.
19.
Bansal
N
,
Roy
J
,
Chen
HY
,
Deo
R
,
Dobre
M
,
Fischer
MJ
,
Evolution of echocardiographic measures of cardiac disease from CKD to ESRD and risk of all-cause mortality: findings from the CRIC study
.
Am J Kidney Dis
.
2018 Sep
;
72
(
3
):
390
9
. .
20.
Mitchell
GF
,
Lacourcière
Y
,
Ouellet
JP
,
Izzo
JL
,
Neutel
J
,
Kerwin
LJ
,
Determinants of elevated pulse pressure in middle-aged and older subjects with uncomplicated systolic hypertension: the role of proximal aortic diameter and the aortic pressure-flow relationship
.
Circulation
.
2003 Sep
;
108
(
13
):
1592
8
. .
21.
Pucci
G
,
Hametner
B
,
Battista
F
,
Wassertheurer
S
,
Schillaci
G
.
Pressure-independent relationship of aortic characteristic impedance with left ventricular mass and geometry in untreated hypertension
:
J Hypertens
.
2015 Jan
;
33
(
1
):
153
60
.
22.
Buckberg
GD
,
Fixler
DE
,
Archie
JP
,
Hoffman
JI
.
Experimental subendocardial ischemia in dogs with normal coronary arteries
.
Circ Res
.
1972 Jan
;
30
(
1
):
67
81
.
23.
Ekart
R
,
Bevc
S
,
Hojs
N
,
Hojs
R
.
Derived subendocardial viability ratio and cardiovascular events in patients with chronic kidney disease
.
Cardiorenal Med
.
2019
;
9
(
1
):
41
50
.
24.
Di Micco
L
,
Salvi
P
,
Bellasi
A
,
Sirico
ML
,
Di Iorio
B
.
Subendocardial viability ratio predicts cardiovascular mortality in chronic kidney disease patients
.
Blood Purif
.
2013
;
36
(
1
):
26
8
. .
25.
Chemla
D
,
Hébert
JL
,
Coirault
C
,
Zamani
K
,
Suard
I
,
Colin
P
,
Total arterial compliance estimated by stroke volume-to-aortic pulse pressure ratio in humans
.
Am J Physiol
.
1998 Feb
;
274
(
2
):
H500
5
. .
26.
de Simone
G
,
Roman
MJ
,
Koren
MJ
,
Mensah
GA
,
Ganau
A
,
Devereux
RB
.
Stroke volume/pulse pressure ratio and cardiovascular risk in arterial hypertension
.
Hypertension
.
1999 Mar
;
33
(
3
):
800
5
.
27.
Zanotto
T
,
Mercer
TH
,
van der Linden
ML
,
Traynor
JP
,
Petrie
CJ
,
Doyle
A
,
Baroreflex function, haemodynamic responses to an orthostatic challenge, and falls in haemodialysis patients
.
PLoS One
.
2018
;
13
(
12
):
e0208127
.
28.
Gallieni
M
,
Butti
A
,
Guazzi
M
,
Galassi
A
,
Cozzolino
M
,
Brancaccio
D
.
Impaired brachial artery endothelial flow-mediated dilation and orthostatic stress in hemodialysis patients
.
Int J Artif Organs
.
2008 Jan
;
31
(
1
):
34
42
.
29.
Hathaway
DK
,
Cashion
AK
,
Wicks
MN
,
Milstead
EJ
,
Gaber
AO
.
Cardiovascular dysautonomia of patients with end-stage renal disease and type I or type II diabetes
.
Nurs Res
.
1998 Jun
;
47
(
3
):
171
9
.
30.
Tahvanainen
A
,
Koskela
J
,
Tikkakoski
A
,
Lahtela
J
,
Leskinen
M
,
Kähönen
M
,
Analysis of cardiovascular responses to passive head-up tilt using continuous pulse wave analysis and impedance cardiography
.
Scand J Clin Lab Invest
.
2009
;
69
(
1
):
128
37
.
31.
Tahvanainen
AM
,
Tikkakoski
AJ
,
Leskinen
MH
,
Nordhausen
K
,
Kähönen
M
,
Kööbi
T
,
Supine and upright haemodynamic effects of sublingual nitroglycerin and inhaled salbutamol: a double-blind, placebo-controlled, randomized study
.
J Hypertens
.
2012 Feb
;
30
(
2
):
297
306
.
32.
Koskela
JK
,
Tahvanainen
A
,
Haring
A
,
Tikkakoski
AJ
,
Ilveskoski
E
,
Viitala
J
,
Association of resting heart rate with cardiovascular function: a cross-sectional study in 522 Finnish subjects
.
BMC Cardiovasc Disord
.
2013
;
13
:
102
.
33.
Levey
AS
,
Stevens
LA
,
Schmid
CH
,
Zhang
YL
,
Castro
AF
,
Feldman
HI
,
A new equation to estimate glomerular filtration rate
.
Ann Intern Med
.
2009 May
;
150
(
9
):
604
12
.
34.
Choudhary
MK
,
Eräranta
A
,
Koskela
J
,
Tikkakoski
AJ
,
Nevalainen
PI
,
Kähönen
M
,
Atherogenic index of plasma is related to arterial stiffness but not to blood pressure in normotensive and never-treated hypertensive subjects
.
Blood Press
.
2019 May
;
28
(
3
):
157
67
.
35.
Koponen
P
,
Borodulin
K
,
Lundqvist
A
,
Sääksjärvi
K
,
Koskinen
S
.
Terveys, toimintakyky ja hyvinvointi Suomessa: FinTerveys 2017 – tutkimus [Internet]
. Available from: http://www.julkari.fi/bitstream/handle/10024/136223/Rap_4_2018_FinTerveys_verkko.pdf?sequence=1&isAllowed=y.
36.
Ku
E
,
Lee
BJ
,
Wei
J
,
Weir
MR
.
Hypertension in CKD: core curriculum 2019
.
Am J Kidney Dis
.
2019 Jul
;
74
(
1
):
120
31
.
37.
Foley
RN
,
Parfrey
PS
,
Harnett
JD
,
Kent
GM
,
Murray
DC
,
Barré
PE
.
The prognostic importance of left ventricular geometry in uremic cardiomyopathy
.
J Am Soc Nephrol
.
1995 Jun
;
5
(
12
):
2024
31
.
38.
Zoccali
C
,
Benedetto
FA
,
Mallamaci
F
,
Tripepi
G
,
Giacone
G
,
Stancanelli
B
,
Left ventricular mass monitoring in the follow-up of dialysis patients: prognostic value of left ventricular hypertrophy progression
.
Kidney Int
.
2004 Apr
;
65
(
4
):
1492
8
.
39.
Vlachopoulos
C
,
O’rourke
M
.
Genesis of the normal and abnormal arterial pulse
.
Curr Probl Cardiol
.
2000 May
;
25
(
5
):
303
67
. .
40.
Chemla
D
,
Plamann
K
,
Nitenberg
A
.
Towards new indices of arterial stiffness using systolic pulse contour analysis: a theoretical point of view
.
J Cardiovasc Pharmacol
.
2008 Feb
;
51
(
2
):
111
7
.
41.
Bargiotas
I
,
Bollache
E
,
Mousseaux
E
,
Giron
A
,
de Cesare
A
,
Redheuil
A
,
MR and applanation tonometry derived aortic impedance: association with aging and left ventricular remodeling
.
J Magn Reson Imaging
.
2015 Feb
;
41
(
3
):
781
7
. .
42.
Payne
RA
,
Lilitkarntakul
P
,
Dhaun
N
,
Melville
V
,
Asai
T
,
Goddard
J
,
Renal dysfunction does not affect the peripheral-to-central arterial pressure transfer function
.
Hypertension
.
2010 Dec
;
56
(
6
):
1083
8
.
43.
O’Rourke
MF
,
Safar
ME
.
Relationship between aortic stiffening and microvascular disease in brain and kidney: cause and logic of therapy
.
Hypertension
.
2005 Jul
;
46
(
1
):
200
4
.
44.
Goff
DC
,
Lloyd-Jones
DM
,
Bennett
G
,
Coady
S
,
D’Agostino
RB
,
Gibbons
R
,
2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association task force on practice guidelines
.
Circulation
.
2014 Jun
;
129
(
25_Suppl l_2
):
S49
73
. .
45.
Gregg
LP
,
Hedayati
SS
.
Management of traditional cardiovascular risk factors in CKD: what are the data?
Am J Kidney Dis
.
2018 Feb
;
72
(
5
):
728
44
.
46.
Chen
TK
,
Knicely
DH
,
Grams
ME
.
Chronic kidney disease diagnosis and management: a review
.
JAMA
.
2019 Oct
;
322
(
13
):
1294
304
.
47.
Rossignol
P
,
Massy
ZA
,
Azizi
M
,
Bakris
G
,
Ritz
E
,
Covic
A
,
The double challenge of resistant hypertension and chronic kidney disease
.
Lancet
.
2015 Oct
;
386
(
10003
):
1588
98
. .
48.
Helve
J
,
Finne
P
,
Groop
PH
.
Finnish registry for kidney diseases report 2018 [Internet]
.
2020 May
. Available from: https://www.muma.fi/files/4770/Finnish_Registry_for_Kidney_Diseases_Report_2018.pdf.
49.
Raggi
P
,
Boulay
A
,
Chasan-Taber
S
,
Amin
N
,
Dillon
M
,
Burke
SK
,
Cardiac calcification in adult hemodialysis patients: a link between end-stage renal disease and cardiovascular disease?
J Am Coll Cardiol
.
2002 Feb
;
39
(
4
):
695
701
.
50.
London
GM
,
Guérin
AP
,
Marchais
SJ
,
Métivier
F
,
Pannier
B
,
Adda
H
.
Arterial media calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality
.
Nephrol Dial Transplant
.
2003 Sep
;
18
(
9
):
1731
40
. .
51.
Lioufas
NM
,
Pedagogos
E
,
Hawley
CM
,
Pascoe
EM
,
Elder
GJ
,
Badve
SV
,
Aortic calcification and arterial stiffness burden in a chronic kidney disease cohort with high cardiovascular risk: baseline characteristics of the impact of phosphate reduction on vascular end-points in chronic kidney disease trial
.
Am J Nephrol
.
2020 Feb
;
51
(
3
):
201
15
.
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