The Effect Of Different Dialysis Methods On Ambulatory Arterial Stiffness Index In Elderly Patients With End-stage Renal Disease

Objective:The aim of this study was to analyze the effects of different dialysis modalities(hemodialysis and peritoneal dialysis)on ambulatory arterial stiffness index(AASI)in elderly patients with end-stage renal disease,and analyze the correlation between AASI and blood pressure,blood lipid,body mass index and dialysis adequacy.This study aiso compare the incidence of cardiovascular events in different dialysis modalities and the benefits of different dialysis modalities in order to guide the choice of dialysis modalities in the elderly.Method :In this study,171 elderly end-stage renal disease patients were selected in the First Affiliated Hospital of Chengdu Medical College from July 2015 to July 2016.According to their needs and clinical judgments,patients were divided into the hemodialysis group(57 persons),peritoneal dialysis with low calcium peritoneal fluid group(57 persons)and peritoneal dialysis with normal calcium peritoneal fluid group(57 persons).This study collected AASI,SBP,DBP,PP,BMI,blood lipid indicators(TG,TC,HDL,LDL),IMT,and serum Ca in all patients before dialysis(baseline),3 months,6 months,and December.we also observe the differences of indicators in different periods and the correlation between AASI and other indicators.The correlation between AASI and adequacy of dialysis in each group after December was analyzed,and the incidence of major adverse cardiovascular events in each group was observed in this study.Results :1.Three groups of patients AASI,SBP,DBP,PP,BMI,blood lipids four indicators(TG,TC,HDL,LDL),IMT and serum Ca level:1)Before dialysis,there was no significant difference in baseline AASI,SBP,DBP and PP levels,BMI,blood lipids,IMT and serum Ca levels between the three groups(P > 0.05).2)After three months and six months of follow-up,there was no statistically significant difference in the above indexes between the three groups and the baseline levels(P > 0.05),and the above indexes were not statistically significant(P > 0.05).3)After nine months of follow-up,there was a statistical difference between the AASI level of the three groups and the baseline levels(P < 0.05),and there was no statistical difference between the residual and baseline values(P > 0.05),and there was no statistically significant difference between the groups(P > 0.05).4)After twelve months of follow-up,the AASI and SBP of the three groups were significantly higher than the baseline levels of their own group,the difference was statistically significant(P < 0.05),and there was no statistical difference between the remaining indexes and baseline values(P > 0.05).There was no significant difference between the groups(P > 0.05).5)The results of correlation analysis suggest that:AASI at baseline and follow up two years after December showed positive correlation with IMT,BMI and lipid index(TC,TG,LDL)(P<0.05).However,there was no significant correlation between AASI and serum calcium and HDL(P > 0.05).2.The correlation between AASI level and adequacy of dialysis after December was analyzed.1)The AASI in the normal peritoneal dialysis group,the low calcium group of peritoneal dialysis and the 3 groups in the hemodialysis group were negatively correlated with the dialysis adequacy in each group(r1=-0.377,r2=-0.397,r3=-0.611,P<0.05).2)The correlation between hemodialysis adequacy and AASI is greater than peritoneal dialysis.3.Major adverse cardiac events:Follow up since December,among the patients who were followed up with no abnormal increase in AASI,the incidence of major adverse cardiac events in the hemodialysis group,the normal peritoneal dialysis group and the low calcium dialysate group were 3.85%,4.76% and 3.85% respectively,and there was no statistical difference between the three groups(P > 0.05).The incidence of major adverse cardiac events in the hemodialysis group(14.71%)was greater than that of the normal peritoneal dialysis group(8.34%)and the low calcium group(6.45%)in the peritoneal dialysis group(P < 0.05),respectively.Conclusion:1)After one years of dialysis,the AASI and systolic pressure of the elderly ERSD patients were significantly higher than those before dialysis,and AASI was positively correlated with IMT,BMI and blood lipid(TC,TG,LDL),but the different dialysis methods had no significant effect on AASI.2)After one years of dialysis,the AASI of elderly patients was negatively correlated with dialysis adequacy,and the correlation between hemodialysis adequacy and AASI was greater than that of peritoneal dialysis.3)In the first years of dialysis,among the abnormally high AASI,the incidence of major adverse cardiac events was higher in hemodialysis patients than in peritoneal dialysis patients,the calcium concentration in peritoneal dialysis had no significant effect on the incidence of major adverse cardiac events in patients with peritoneal dialysis.