title: Cardio-ankle vascular index and ankle pulse wave velocity as a marker of arterial fibrosis in kidney failure treated by hemodialysis.
abstract: BACKGROUND
  Patients with kidney failure treated with hemodialysis have a high incidence of cardiovascular diseases caused by accelerated arteriosclerosis. However, accurate evaluation of the extent of arteriosclerosis is difficult. This study sought to compare the strength of predictions of arterial fibrosis by using a new parameter, the cardio-ankle vascular index (CAVI), versus pulse wave velocity (PWV) in patients with kidney failure treated with hemodialysis.
  
  
  METHODS
  Diagnostic test study.
  
  
  METHODS
  103 patients with kidney failure undergoing surgical construction of an arteriovenous access for hemodialysis therapy.
  
  
  METHODS
  CAVI and PWV.
  
  
  METHODS
  Arterial fibrosis, evaluated by using Masson trichrome stain on part of the brachial artery obtained during surgery, expressed as percentage of fibrosis of the layer of vascular smooth muscle cells.
  
  
  RESULTS
  Median percentage of arterial stiffness was 52.85%. Mean PWV and CAVI were 18.3 +/- 5.6 (SD) m/s and 9.9 +/- 2.6, respectively. Multivariate regression analysis showed that arterial fibrosis was significantly associated with older age (0.247%/y; 95% confidence interval, 0.013 to 0.482) and CAVI (6.117%/unit; 95% confidence interval, 4.764 to 4.740), but not with systolic blood pressure (0.039%/mm Hg; 95% confidence interval, -0.076 to 0.153) or PWV (-0.044%/m/s; 95% confidence interval, -0.646 to 0.558). The area under the receiver operating characteristic curve to predict greater than median percentage of arterial stiffness was 0.892 for CAVI and 0.779 for PWV (P = 0.006).
  
  
  CONCLUSIONS
  It is unclear whether arterial fibrosis of the brachial artery evaluated by using CAVI is applicable for arteriosclerosis of other arterial districts, and clinical outcomes were not evaluated in this study.
  
  
  CONCLUSIONS
  CAVI reflects the histological arterial fibrosis of hemodialysis patients and is a useful clinical marker for evaluating arterial stiffness in these patients.
authors.affiliation: Internal Medicine, Keio University School of Medicine, Tokyo, Japan. atzichi@sc.itc.keio.ac.jp
authors.forename: Atsuhiro
authors.initials: A
authors.lastname: Ichihara
authors.forename: Norimasa
authors.initials: N
authors.lastname: Yamashita
authors.forename: Tomoko
authors.initials: T
authors.lastname: Takemitsu
authors.forename: Yuki
authors.initials: Y
authors.lastname: Kaneshiro
authors.forename: Mariyo
authors.initials: M
authors.lastname: Sakoda
authors.forename: Asako
authors.initials: A
authors.lastname: Kurauchi-Mito
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Itoh