Relationship between fluctuation pattern of blood pressure during hemodialysis treatment and cardiovascular morphology: An autopsy study of 53 cases

Background: Cardiovascular morphological changes are often conspicuous in a utopsy examination of chronic hemodialysis (HD) patients. On the other hand , the fluctuation pattern in blood pressure (BP) during HD treatment varies from one patient to another. Cardiovascular changes may correlate with cli nical findings including BP fluctuation patterns during HD, although no aut opsy studies have previously examined this issue. Methods: In this study, 5 3 autopsies of patients who had been on chronic HD were reviewed. We determ ined the relationship between BP fluctuation during HD treatment along with stable and cardiovascular morphology, including heart weight, ventricular wall thickness, circumferences of the valves and the severity of aortic art eriosclerosis and coronary stenosis. Patients were divided into 4 groups ac cording to the pattern of BP fluctuation during HD treatment at about 6 mon ths before death: group 1 (n = 13), symptomatic hypotension and/or decline pat tern during HD; group 2 (n = 11), continuously high BP during HD treatm ent; group 3 (n = 17), continuous normal BP during HD treatment, and group 4 (n = 12), continuously low BP without symptomatic hypotension during HD t reatment. Results: Heart weight and ventricular wall thickness were greates t in group 2. The scores for aortic arteriosclerosis in groups 1 and 2 were higher than in groups 3 and 4. The coronary stenosis index was significant ly higher in group 1 than in the other groups, and that in group 2 was high er than in group 4. Multiple regression analysis showed that age, HD durati on and pulse pressure were independent variables for the score of arteriosc lerosis, and the decline pattern of BP fluctuation during HD and pulse pres sure were independent variables for coronary stenosis index. Conclusions: O ur results suggest that certain clinical parameters including BP during HD may reflect cardiovascular morphological changes in stable HD patients, alt hough further examination, such as 24-hour blood pressure measurement is re commended to elucidate the pathophysiology of cardiovascular diseases in HD patients. Copyright (C) 2001 S. Karger AG, Basel.