Impact of brachial-ankle pulse wave velocity and ankle-brachial blood pressure index on mortality in hemodialysis patients.
BACKGROUND
Pulse wave velocity (PWV) and ankle-brachial blood pressure index (ABPI) are markers for atherosclerosis, and each predicts mortality in patients undergoing hemodialysis. However, there have been no studies in the past that compared head-to-head the clinical validity of these 2 parameters. Compared with conventional aortic PWV, brachial-ankle PWV (baPWV) is considered simple and thereby easily applicable to clinical use.


METHODS
To clarify the relationship between baPWV and ABPI and assess their prognostic values, we analyzed 785 hemodialysis patients with a mean age of 60.2 +/- 12.5 (SD) years for whom ABPI and baPWV at baseline had been measured simultaneously and who were followed up for 33.8 +/- 10.8 months.


RESULTS
Of 785 patients, 131 deaths were recorded. In Kaplan-Meier analysis, all-cause mortality was progressively and significantly greater from the lowest quartile of baPWV onward (log-rank test, 41.8; P < 0.001). However, in Cox proportional hazards analysis, the impact of baPWV was insignificant when ABPI was included as a covariate. ABPI maintained strong predictive power in this model. When patients who had advanced peripheral arterial occlusive disease (ABPI < 0.9) were excluded from analysis, patients with the highest quartile of baPWV had significantly increased hazard ratios of all-cause (hazard ratio, 4.08; 95% confidence interval, 1.46 to 11.43; P < 0.007) and cardiovascular (hazard ratio, 7.03; 95% confidence interval, 1.49 to 33.08; P < 0.014) mortality. The predictive power of baPWV in this population was independent from other covariates associated with atherosclerotic disorders.


CONCLUSIONS
In a head-to-head comparison, ABPI, but not baPWV, showed strong power in predicting the mortality of hemodialysis patients. However, baPWV was useful to pick a high-risk population in patients with ABPI greater than 0.9. Thus, screening hemodialysis patients by means of baPWV and ABPI provides complementary information in identifying a high-risk population.
Kitahara
Tokuyuki
T
Department of Medicine and Clinical Science, Gunma Graduate School of Medicine, Maebashi, Japan.
Ono
Kumeo
K
Tsuchida
Akiyasu
A
Kawai
Hironobu
H
Shinohara
Masahiko
M
Ishii
Yoshitaka
Y
Koyanagi
Hikaru
H
Noguchi
Toshiharu
T
Matsumoto
Takayuki
T
Sekihara
Tetsuo
T
Watanabe
Yukiyasu
Y
Kanai
Hideo
H
Ishida
Hideki
H
Nojima
Yoshihisa
Y
D000328:Adult; D000368:Aged; D000842:Ankle; D001132:Arm; D001161:Arteriosclerosis / Q000150:complications / Q000503:physiopathology*; D001783:Blood Flow Velocity; D001794:Blood Pressure; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011674:Pulse; D006435:Renal Dialysis; D012907:Smoking