Association between environmental particulate matter and arterial stiffness in patients undergoing hemodialysis
Weng et al. BMC Cardiovascular Disorders
Association between environmental particulate matter and arterial stiffness in patients undergoing hemodialysis
Cheng-Hao Weng 0 1
Ching-Chih Hu 0 2
Tzung-Hai Yen 0 1
Wen-Hung Huang 0 1
0 College of Medicine, Chang Gung University , Taoyuan , Taiwan
1 Department of Nephrology, Chang Gung Memorial Hospital , Linkou, 5 Fu-Shin Street, Kwei-Shan 333, Taoyuan , Taiwan
2 Department of Hepatogastroenterology and Liver Research Unit, Chang Gung Memorial Hospital , Keelung , Taiwan
Background: Aortic pulse wave velocity (PWV) has been shown to be an independent predictor of cardiovascular mortality in patients with end-stage renal disease and the general population. Atmospheric particulate- matter (PM) concentrations and their effects on cardiovascular system by affecting arterial stiffness and central hemodynamic parameters had been noted. The purpose of this study was to access the correlation of air pollution variables and PWV in patients undergoing hemodialysis (HD). Methods: This study analyzed 127 HD patients treated at the outpatient HD center. Brachial-ankle pulse wave velocity (baPWV) was measured by using a Vascular Profiler 1000 (VP-1000). Air pollution levels were recorded by a network of 27 monitoring stations near or in the patients' living areas throughout Taiwan. The 12-month average concentrations of PM with an aerodynamic diameter of <10 and <2.5 mm (PM10 and PM2.5, respectively), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide(CO), and ozone (O3) were included. Results and Discussion: Multivariate linear regression analyses indicated that systolic blood pressure (SBP) (β = 0.589, P < 0.025), age (β = 0.316, P < 0.001), serum aluminum level (Al) (β = 0.149, P = 0.020), and PM10 (β = 0.133, P = 0.036) were positively correlated with baPWV. Conclusion: This cross-sectional study shows that in HD patients, the environmental PM10 level is associated with the baPWV.
Hemodialysis; Pulse wave velocity; Particulate matter
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Background
Patients with end-stage renal disease undergoing
hemodialysis (HD) have high rates of morbidity and mortality.
Cardiovascular diseases account for almost half of this
mortality [1]. Aortic pulse wave velocity (PWV) has been
shown to be an independent predictor of cardiovascular
mortality in patients with end-stage renal disease and
the general population [2]. Brachial-ankle pulse wave
velocity (baPWV) is an accurate indicator of aortic PWV
measured by intra-aortic catheter by volume-rendering
[3]. We have previous shown that serum aluminum level
(Al) was positively associated with baPWV after
correction of other known risk factors [4]. Adamopoulos et al.
[5] analyzed the atmospheric pollution variables,
including atmospheric particulate- matter (PM) concentrations
and their effects on cardiovascular system by affecting
arterial stiffness and central hemodynamic parameters,
and found that in men, PM10 air pollution levels were
associated with heightened amplitude of PWV. Our
recently study also showed that variables of air pollution
levels were associated with 2-year mortality, level of
high sensitivity C-reactive protein (hsCRP), and dialysis
related infections in patients undergoing peritoneal
dialysis [6–8]. The purpose of this study was to access the
correlation of air pollution variables and baPWV in
patients undergoing HD, which had never been studied
before.
© 2015 Weng et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
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Methods
Ethics statement
This study complied with the guidelines of the Declaration
of Helsinki and was approved by the Medical Ethics
Committee of Chang Gung Memorial Hospital (Institutional
Review Board approval number: 101-5199B), a tertiary
referral center located in the northern part of Taiwan.
Written informed consent for this cross-sectional and
publication of these data were obtained from every
patient. All data were protected securely and only available
to researchers; the data were also analyzed without
patients’ names.
Subjects
One hundred and thirty eight HD patients treated at the
outpatient HD center at Chang Gung Memorial Hospital
in Taoyuan, Taiwan were analyzed. To diagnose
peripheral arterial occlusive disease (PAOD), the ankle-brachial
blood pressure index (ABPI) was developed. PAOD has
a reliable and accepted marker, which is when ABPI is
less than 0.9. Severe PAOD decreases baPWV due to
decreased internal pressure and blood flow. Therefor (...truncated)