BACKGROUND Arterial stiffness is a strong predictor of death and cardiovascular (CV) events in hemodialysis patients. Only few studies tested interventions aiming to improve arterial stiffness in this population. This study examines the effect of dry-weight reduction with a standardized lung-ultrasound-guided strategy on ambulatory aortic blood pressure (BP) and arterial stiffness parameters in hemodialysis. METHODS Seventy-one clinically euvolemic hemodialysis patients with hypertension, were included in this single-blind randomized clinical-trial. Patients were randomized in the active group (n = 35), following dry-weight reduction guided by the total number of US-B lines before a mid-week dialysis session and the control group (n = 36), following standard treatment. Patients underwent office evaluation of arterial stiffness and 48-h ABPM to capture ambulatory central systolic (cSBP) and diastolic BP (cDBP) and arterial stiffness indexes at baseline and after 8-weeks. RESULTS US-B lines decreased in the active and slightly increased in the control group (p < 0.001) during follow-up. Office-pulse-wave-velocity (PWV) decreased from baseline to study-end only in the active group, resulting in significant between-group differences (- 0.25 ± 0.71 vs 0.20 ± 1.18 m/s p = 0.037). Reduction in 48-h-cSBP (- 6.30 ± 8.90 vs - 0.50 ± 12.46; p = 0.027) was greater and in cDBP (- 3.85 ± 6.61 vs - 0.63 ± 8.36; p = 0.077) marginally greater in the active compared to control group. 48-h-central-pulse-pressure (cPP, 41.51 ± 9.63 vs 39.06 ± 9.61 mmHg; p = 0.004) and 48-h-PWV (9.30 ± 2.00 vs 9.08 ± 2.04 m/s p = 0.032) were significantly reduced during follow-up in the active group and were unchanged in controls, resulting in significant between-group differences. In contrast, 48-h-AIx and AIx(75) were not different between the two groups. CONCLUSION Lung-ultrasound-guided dry-weight reduction decreased ambulatory aortic-BP and ambulatory or office-PWV, but not ambulatory-AIx(75). These results suggest that dry-weight reduction is an important treatment approach to improve these cardiovascular risk factors in hemodialysis.

中文翻译：

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肺部超声评估后去除多余的体积会降低血液透析患者的中心血压和脉搏波速度：LUST 子研究。

背景动脉僵硬度是血液透析患者死亡和心血管（CV）事件的强预测因子。只有少数研究测试了旨在改善该人群动脉僵硬度的干预措施。本研究检查了采用标准化肺超声引导策略减轻干重对动态主动脉血压 (BP) 和血液透析中动脉僵硬度参数的影响。方法 该单盲随机临床试验纳入了 71 名临床常血容量型高血压患者。患者随机分为活跃组（n = 35），在一周中期透析之前根据 US-B 线总数指导干重减轻，而对照组（n = 36）则在标准治疗后。患者接受了动脉僵硬度和 48 小时 ABPM 的办公室评估，以捕获基线和 8 周后的动态中央收缩压 (cSBP) 和舒张压 (cDBP) 以及动脉僵硬度指数。结果 随访期间，活动组的 US-B 线减少，对照组略有增加（p < 0.001）。办公室脉搏波速度 (PWV) 从基线到研究结束仅在活动组中降低，导致显着的组间差异（- 0.25 ± 0.71 vs 0.20 ± 1.18 m/sp = 0.037）。48-h-cSBP（- 6.30 ± 8.90 vs - 0.50 ± 12.46; p = 0.027）的降低更大，cDBP（- 3.85 ± 6.61 vs - 0.63 ± 8.36; p = 0.077）与主动对照组相比略微更大组。48 小时中央脉冲压力（cPP，41.51 ± 9.63 与 39.06 ± 9.61 mmHg；p = 0.004）和 48 小时 PWV（9.30 ± 2.00 与 9.08 ± 2.04 m/sp = 0。032) 在活性组的随访期间显着降低，而在对照组中没有变化，导致显着的组间差异。相比之下，两组之间的 48-h-AIx 和 AIx(75) 没有差异。结论 肺超声引导的干重减少降低了动态主动脉血压和动态或办公室 PWV，但不降低动态 AIx(75)。这些结果表明，减少干重是改善血液透析中这些心血管危险因素的重要治疗方法。但不是动态 AIx(75)。这些结果表明，减少干重是改善血液透析中这些心血管危险因素的重要治疗方法。但不是动态 AIx(75)。这些结果表明，减少干重是改善血液透析中这些心血管危险因素的重要治疗方法。