PROPOSAL

The Differences Pulse Wave Velocity in hypertensive and chronic

dialysis out patients
Background
Compared to the general population, patients with hypertension and CKD have an
increased risk of premature death from cardiovascular disease. In fact, patients with
CKD are 16-40 times more likely to die from cardiovascular disease than progress to
end stage renal disease [2]. Measures of arterial stiffness have been demonstrated
to be important when assessing cardiovascular risk [3, 4, 5, 6, 7].
People with kidney failure have a higher chance of getting disease in the blood
vessels and this result in a decreased elasticity of the arteries of their body which
make them very stiff or hard. It appears that stiffer arteries with a decreased
elasticity increase the risk of stroke and heart disease. A novel way to know the
stiffness of blood vessels is by a method called "applanation tonometry", which
measures the "pulse wave velocity" of major blood vessels such as the aorta,
carotid and femoral arteries. The purpose of our study is to determine if we can
measure arterial stiffness reliably and accurately using in people with kidney failure
receiving hemodialysis treatments at our centre. If we demonstrate that the method
is reliable and accurate if we can use measures of arterial stiffness to evaluate the
risk of stroke and heart disease in people with kidney failure receiving hemodialysis.
The research study had been taken place at the Hassan Basry Hospital

Condition
Hypertension

Intervention
Applanation tonometry

End-Stage Renal Disease

Study Type:

Observational

Study

Observational Model: Cross-sectional

Design:

Official Title:

The Differences Pulse Wave Velocity in hypertensive and chronic dialysis out
patients

Primary Outcome Measures:

We would estimated carotid-femoral Pulse Wave Velocity differences in outpatients hypertension at
integrated clinic hypertension and with chronic hemodialysis at Hassan Basry Hospital .

Estimated Enrollment:

40

Study Start Date:

January 2015

Estimated Study Completion Date:

February 2015

Estimated Primary Completion

December 2015 (Final data collection date for primary

Date:

outcome measure)

Groups

Assigned Interventions

Hypertension Subjects group

Other: Applanation tonometry

A group of 20 hypertension at the intergrated

Two consecutive sets of carotid-femoral Pulse

clinic hypertension Hassan Basry Hospital.

Wave Velocity (PWV) measurements by

Measurements of arterial stiffness will be

Applanation tonometry with a time-interval of 1

performed by Applanation tonometry.

week will be obtained (1 week 2 days). Two

research assistants will each perform a carotidfemoral-PWV measurement at each time point
with the testing order randomized.
Other Name: carotid-femoral Pulse wave
velocity (c-f-PWV)

Hemodialysis Subjects group

Other: Applanation tonometry

A group of 20 patients with stage 5 Chronic

Two consecutive sets of carotid-femoral Pulse

Kidney Disease (estimated glomerular filtration

Wave Velocity (PWV) measurements by

rate <15 ml/min/m2), who attend chronic

Applanation tonometry with a time-interval of 1

hemodialysis treatments at The Hasan Basry

week will be obtained (1 week 2 days). Two

Hospital will be invited to participate.

research assistants will each perform a carotid-

Measurements of arterial stiffness will be

femoral-PWV measurement at each time point

performed in this group by Applanation

with the testing order randomized.

tonometry.

Other Name: carotid-femoral Pulse wave

velocity (c-f-PWV)

Detailed Description:
Methods:
PWV will be measured consecutively by 2 research assistants in: a) a group of 20 healthy subjects;
and b) a group of 20 patients with ESRD on chronic hemodialysis at The Ottawa Hospital. Two
consecutive sets of PWV measurements with a time-interval of 1 week ( 2 days) will be obtained in
the healthy and ESRD groups (pre-hemodialysis, between 2 consecutive mid-week hemodialysis
sessions). To determine the impact of hemodialysis on PWV measures, in a sub-group of 10 ESRD

subjects measurements will be taken before and after hemodialysis. The order of testing by the 2
assistants will be randomized.

Eligibility
Ages Eligible for Study:

18 Years and older

Genders Eligible for Study:

Both

Accepts Healthy Volunteers:

Yes

Sampling Method:

Non-Probability Sample

Study Population
SUBJECTS: Fourty patients with hypertension and Dialysis who attend chronic hemodialysis
treatments and at integrated hypertension clinic Hassan Basry Hospital.

Criteria.
END-STAGE RENAL DISEASE (ESRD) GROUP
Inclusion Criteria:

Adult patient (age: >18 years) with ESRD (estimated glomerular filtration rate: <15
ml/min/m2)

Receiving hemodialysis treatments, with no expected renal recovery

Having received regular in-Centre Hemodialysis at HBH for at least the past 3 weeks

Able to provide informed consent.

HYPERTENSION GROUP
Inclusion Criteria:

Adult patient (age: >18 years) with Hypertension.

Able to provide informed consent

Exclusion Criteria:

Atrial fibrillation (as it frequently results in transient or persistent rapid heart rates and these
changes overestimate aortic stiffness).

Active cancer or history of cancer in the past 5 years.

Pregnancy

Any condition that limit the patient's ambulatory ability and preclude participation on this
basis

Mechanical, bioprosthetic heart valves or mechanical assisting devices (these conditions

may change myocardial stiffness and the volumetric properties of the left ventricle leading to
diastolic dysfunction and these physiologic changes may modify the waveforms of the cf- APWV).

Pre-dialysis systolic blood pressure 200 mm Hg recorded in the last 6 dialysis treatments
(2 weeks).

Inability to measure blood pressure in at least one arm.

Current smoker (>15 cigarettes per day) in the last 6 months [Daily cigarette consumption
(>15 cigarettes per day) adjusted by age, education level and other confounders has been found to
be independently associated with the risk of hypertension