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Background: Association of Ambulatory Blood Pressure Monitoring (ABPM) with mortality depends on cardiac function in hemodialysis patients. Evidence for the predictive power of central Systolic Pressure (cSBP) is inconclusive. Thus, this study aimed to investigate the additional information of ambulatory cSBP in risk prediction in a cohort of hemodialysis patients. Methods: Within the ISAR-study cohort, 344 hemodialysis patients underwent 24 h ABPM on the dialysis day. All-cause and cardiovascular mortality served as endpoints. Risk prediction was performed using Cox regression in patients with or without atrial fibrillation (AF) or heart failure (HF) for peripheral (pSBP) and central systolic pressure calibrated with peripheral systolic and diastolic pressure (cSBP1) or peripheral mean and diastolic pressure (cSBP2). Results: During a mean follow-up of 37.6 (17.5 SD) months, 115 patients died, of whom 47 due to cardiovascular reasons. In patients with AF or HF, a negative association to mortality could be observed, independent of pressure location and calibration (see Table). In patients without AF or HF, these associations were to the opposite directions and cSBP2 was superior to pSBP and cSBP1 for all-cause (pSBP: HR = 1.01, p = 0.30; cSBP1: HR = 1.00, p = 0.77; cSBP2: HR = 1.01, p = 0.06) and cardiovascular (pSBP: HR =1.03, p = 0.02; cSBP1: HR = 1.02, p = 0.06; cSBP2: HR = 1.03, p = 0.003) mortality. This circumstance was confirmed in multivariable analysis combining pSBP and differences between pSBP and cSBP (see Table). Conclusions: This study provides evidence for the additional information of central systolic blood pressure and its dependency on calibration in risk prediction in hemodialysis patients. Further studies are needed to confirm these findings.

Objectives: Mortality rate in end-stage renal disease (ESRD) are still at a high level. Sarafidis et al. showed the predictive value of 48h PWV in patients undergoing hemodialysis [1], although recent studies using office measurement showed controversial predictive results. Aim of the present study was to confirm the predictive value of a novel oscillometric measurement of pulse wave velocity on mortality in an elderly cohort of patients with ESRD. Methods: The ISAR study is a prospective and longitudinal study targeting patients with ESRD undergoing hemodialysis. Oscillometric measurement of 24-hour PWV was performed at baseline. Survival analysis included Kaplan-Meier analysis, logrank test and Cox regression. Results: A total of 350 patients had a median age of 69.3 [55.8; 77.3] years. Mean PWV was 9.6 (2.2) m/s and 120 patients died during the mean follow-up of 45 months. PWV was significantly higher in the deceased (10.6 +/− 1.9 m/s) than in surviving patients (9.0 +/− 2.2 m/s). Kaplan-Meier analysis showed differences in dichotomized PWV (cut-off 10 m/s [2]; Logrank test: p = 0.001). For results of univariate Cox regression, see Figure. Adjusted Cox regression analysis showed a significant risk prediction for all-cause mortality (HR 2.322; p = 0.011). Patients older than 50 years showed even higher predictive values (HR 2.442; p = 0.008) as well as patients with PWV values of at least 10 m/s (HR 3.300; p = 0.006). Figure.Univariate hazard-ratios and their 95% confidence intervals for continuous PWV and PWV quartiles (Q1 as reference; ** p = 0.002; *** p < 0.001). Ql: 11.23 m/s. Conclusion: Oscillometric measurement of 24-hour pulse wave velocity is a simple and valid method and has an additional predictive value for all-cause mortality in elderly patients with end-stage renal disease.

Introduction: Heart rate variability (HRV) analysis is a non-invasive tool for assessing the cardiac health. There is evidence that the cardiac autonomic system and central hemodynamics respond to hemodialysis. The aim of this work is to compare HRV parameters and augmentation index (AIx) between intra- and interdialytic periods in patients with end-stage renal disease. Methods: All 24-h electrocardiogram data were obtained using the Lifecard CF digital Holter recorder (Delmar Reynolds/Spacelabs, Germany) and 24-h pulse wave analysis (PWA) measurements were taken with the Mobil-O-Graph 24h PWA (I.E.M. GmbH, Germany) within the ISAR hemodialysis study. Two-hundred patients (132 men / 68 women: 61+−16 years) were included. HRV was analyzed in the time- and frequency-domain in 5-min segments. AIx values and HRV parameters were averaged for intra- and interdialytic periods. Results: The low to high frequency ratio (LF/HF) as a representative of sympathovagal balance (2.85 vs 3.36, p