title: Carotid arterial stiffness as a predictor of cardiovascular and all-cause mortality in end-stage renal disease.
abstract: Damage of large arteries is a major contributory factor to the high pulse pressure observed in patients with end-stage renal disease. Whether incremental modulus of elasticity (Einc), a classic marker of arterial stiffness, can predict cardiovascular mortality has never been investigated. A cohort of 79 patients with end-stage renal disease undergoing hemodialysis was studied between September 1995 and January 1998. Mean age at entry was 58+/-15 years. The duration of follow-up was 25+/-7 months, during which 10 cardiovascular and 8 noncardiovascular fatal events occurred. At entry, carotid Einc was calculated from measurements of diameter, thickness (echo-tracking technique), and pulse pressure (tonometry). Based on Cox analyses, 2 dominant factors emerged as predictors of all-cause and cardiovascular mortality: increased Einc and decreased diastolic blood pressure. Lipid abnormalities and the presence of previous cardiovascular events interfered to a smaller extent. After adjustment for confounding variables, the odds ratio for Einc >/=1 kPa-3 was 9.2 (95% confidence interval, 2.4 to 35.0) for all-cause mortality. These results provide the first direct evidence that in patients with end-stage renal disease undergoing hemodialysis, arterial alterations, as determined from carotid Einc, are strong independent predictors of all-cause and cardiovascular mortality.
authors.affiliation: From the Service de Médecine Interne, Hôpital Broussais, Paris, and Service d'Hémodialyse, Hôpital F.H. Manhès, Fleury-Mérogis, France.
authors.forename: J
authors.initials: J
authors.lastname: Blacher
authors.forename: B
authors.initials: B
authors.lastname: Pannier
authors.forename: A P
authors.initials: AP
authors.lastname: Guerin
authors.forename: S J
authors.initials: SJ
authors.lastname: Marchais
authors.forename: M E
authors.initials: ME
authors.lastname: Safar
authors.forename: G M
authors.initials: GM
authors.lastname: London
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D002339:Carotid Arteries / Q000503:physiopathology*; D015986:Confounding Factors, Epidemiologic; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D004548:Elasticity; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D006435:Renal Dialysis; D011795:Surveys and Questionnaires; D016019:Survival Analysis