Sex Differences in Ambulatory Central Blood Pressure and Arterial Stiffness in Hemodialysis Patients

Introduction Sex differences have a significant role on epidemiology of cardiovascular complications in chronic kidney disease. Among hemodialysis patients, central blood pressure (BP) levels and increased arterial stiffness parameters are independent predictors of cardiovascular and all-cause- mortality. Aim To examine the potential differences in ambulatory central BP and arterial stiffness parameters between male and female hemodialysis patients. Methods A total of 129 male and 91 female hemodialysis patients were included in this analysis. All participants underwent 48-h ambulatory BP monitoring with Mobil-O-Graph-NG; indices of central hemodynamics (SBP, DBP and pulse pressure), wave reflection (augmentation pressure (AP) and augmentation index (AIx)) and pulse wave velocity (PWV) were estimated. Results Age, dialysis vintage and history of major comorbidities did not differ between men and women. Male patients had higher 48-h cSBP (124.7 +/- 15.7 vs. 119.8 +/- 16.7 mmHg, p=0.027) and 48-h DBP (83.7 +/- 12.2 vs. 77.5 +/- 11.9 mmHg, p<0.001) compared to female patients; relevant differences were also evident during the 44-h (excluding hemodialysis), 1st 24-h and 2nd 24-h periods and the corresponding daytime and nighttime periods of the recording. Central pulse pressure did not differ between groups. Regarding wave reflection parameters, AP, AIx, and AIx(75) were significantly lower in males versus females during the 48-h (AIx, 25.6 +/- 8.2 vs. 32.3 +/- 8.6 mmHg, p<0.001), 44-h, 1st and 2nd 24-h and also during respective daytime and nighttime periods. The two groups displayed similar PWV during all studied intervals (48-h PWV, 9.6 +/- 1.9 vs 9.7 +/- 2.1 m/s, p=0.612). Conclusions Male hemodialysis patients present with higher levels of ambulatory central BP but significantly lower levels of AP, AIx and AIx(75) than females. PWV does not differ between sexes.