Effects of Glucose Metabolism on Aortic Pulse Wave Velocity in Hemodialysis Patients with and without Diabetes

To compare the clinical features of aortic stiffness and its contributors between hemodialysis (HD) patients with and those without diabetes, we performed a cross-sectional study of stably treated HD patients (n=242). Aortic stiffness was assessed by measuring carotid-femoral pulse wave velocity (cfPWV). Annual laboratory data, comorbid conditions, and contributors to cfPWV were compared between HD patients with and those without diabetes. Of the 242 patients, 94 had diabetes. The comparison showed that patients with diabetes had a shorter duration of HD; higher systolic blood pressure (SBP), cfPWV, and rate of macrovascular complications; and lower ankle-brachial blood pressure index and concentrations of serum albumin and calcium. Stepwise multiple regression analysis identified age, duration of HD, SBP, heart rate (HR), and HbA1c as independent determinants of cfPWV in nondiabetic HD patients, while only SBP, HbA1c, and duration of diabetes were independent contributors of cfPWV in HD patients with diabetes. Our results indicate that glucose metabolism plays an important role in the promotion of aortic stiffness in both diabetic and nondiabetic HD patients. In particular, hyperglycemia's effect on aortic compliance in HD patients with diabetes is so strong that it negates the effects of the uremic milieu and aging. Follow-up studies are needed to ascertain whether or not strict diabetes management could improve aortic compliance. (Hypertens Res 2008; 31: 1365-1372)