Characteristics And Clinical Significance Of Central Arterial Pressure In Patients With Chronic Kidney Disease

Objective: To investigate the consistency of noninvasive and invasive measurements of central arterial pressure in patients with chronic kidney disease and the characteristics and clinical significance of central arterial pressure in patients with chronic kidney disease.Methods: From May 2018 to December 2018,120 patients who underwent coronary angiography or interventional therapy in the catheterization room of Shenzhen people's Hospital,the second Clinical Medical College of Jinan University,were selected as study subjects.The patients were divided into three groups: CKD3-5 group,dialysis group and control group.The peripheral brachial artery pressure,noninvasive and invasive central artery pressure were measured in the three groups,and the clinical data,laboratory indexes and coronary angiography results were recorded.The consistency of noninvasive and invasive central artery pressure and the difference between peripheral brachial artery pressure and central artery pressure were compared among the three groups.Furthermore,the patients with CKD were divided into two groups according to whether they were complicated with coronary heart disease(CAD).The differences between the two groups were compared and the meaningful indexes were analyzed by binary Logistic regression analysis.Results: There were 50 patients in the control group,50 patients in the CKD3-5 group and 20 patients in the dialysis group.Among them,34 patients with coronary heart disease were complicated with coronary heart disease in the CKD3-5 group and the dialysis group.The consistency between noninvasive central arterial pressure and invasive central arterial pressure was better in the control group and the CKD3-5 group than that in the dialysis group.In the dialysis group,the actual central arterial pressure was underestimated [-9.2(-12.6?-5.7)mm Hg,P<0.001] by the noninvasive equipment A-PULSECASPro.Comparison of peripheral brachial artery pressure and central artery pressure,The difference between peripheral brachial artery pressure and central artery pressure in dialysis group was 3.0(-0.5?6.5)mm Hg,which was significantly lower than that in control group 11.7(10.3?13.2)mm Hg and CKD3-5 group 9.1(6.9?11.4)mm Hg(P< 0.001).Logistic regression analysis showed that the central arterial pulse pressure increased(every 10 mm Hg increase))[OR=1.488,95% CI(1.078,2.054)],central arterial diastolic blood pressure reduction(per 10 mm Hg reduction)[OR=0.581,95% CI(0.356,0.950)],peripheral brachial artery pressure and central arterial pressure difference decreased values(every 1 mm Hg reduction)[OR=0.907,95% CI(0.839,0.982)] were risk factors for coronary heart disease in patients with CKD.Conclusion: Non-invasive equipment A-PULSECASPro underestimates the actual central arterial pressure in dialysis patients;The pulse wave amplification effect in dialysis patients was different from that in CKD3-5 group and control group,the central arterial pressure and peripheral brachial artery pressure were more close to that of peripheral brachial artery pressure,and the magnification effect decreased.The increase of central arterial pulse pressure,the decrease of central arterial diastolic pressure and the decrease of central to peripheral magnification in patients with CKD3-5 and dialysis group were the risk factors for coronary heart disease.