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Excess volume removal following lung ultrasound evaluation decreases central blood pressure and pulse wave velocity in hemodialysis patients: a LUST sub-study

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Abstract

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.

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Acknowledgements

This trial is part of the activities within the European Renal and Cardiovascular Medicine (EURECA-m) working group of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA). Francesca Mallamaci is the current chair, Robert Ekart and Pantelis Sarafidis are Board members of EURECAm; Carmine Zoccali and Gerard London are past chairs and active members of this working group.

Funding

This is a sub-study of the LUST trial, which is funded by the European Renal Association—European Dialysis Transplant Association.

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Authors and Affiliations

  1. Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Charalampos Loutradis, Aikaterini Papagianni, Marieta Theodorakopoulou, Ioanna Minopoulou & Pantelis A. Sarafidis

  2. Department of Nephrology, University Clinical Centre Maribor, Maribor, Slovenia

    Robert Ekart

  3. 3rd Department of Cardiology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Efstathios Pagourelias

  4. 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Stella Douma

  5. 2nd Propaedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Asterios Karagiannis

  6. CNR-IFC Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy

    Francesca Mallamaci & Carmine Zoccali

  7. Hospital and FCRIN INI-CRCTC, Manhes, France

    Gerard London

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  1. Charalampos Loutradis
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Correspondence to Pantelis A. Sarafidis.

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The study protocol was approved by the Ethics Committee of School of Medicine, Aristotle University of Thessaloniki and the Medical School of University of Maribor. LUST study (NCT02310061) and the ABPM sub-study (NCT03058874) are registered with the ClinicalTrials.gov registry.

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Loutradis, C., Papagianni, A., Ekart, R. et al. Excess volume removal following lung ultrasound evaluation decreases central blood pressure and pulse wave velocity in hemodialysis patients: a LUST sub-study. J Nephrol 33, 1289–1300 (2020). https://doi.org/10.1007/s40620-020-00745-w

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