title: Mortality risk in hemodialysis patients with increased arterial stiffness is reduced by attainment of classical clinical performance measures.
abstract: BACKGROUND
  We determined whether attainment of classical clinical performance measures for hemodialysis care improves survival in hemodialysis patients with increased arterial stiffness.
  
  
  METHODS
  We performed a prospective cohort study of 538 hemodialysis patients with a median follow-up of 19 months (interquartile range 8-30). Arterial stiffness was measured using applanation tonometry. Clinical performance measure targets were hemoglobin value >or=110 g/l, serum albumin value >or=37 g/l and measured single-pool Kt/V urea value >or=1.2.
  
  
  RESULTS
  During follow-up, 217 patients (40%) died. In non-survivors, arterial stiffness of large arteries (S1) was significantly higher compared with survivors (p = 0.0002). An analysis of hemodialysis patients who were alive 18 months after inclusion into the study showed that survival was significantly longer in those patients that met >or=2 clinical performance measure targets compared with patients that met <or=1 target (chi(2) 4.13; p = 0.04). Better attainment of classical clinical performance measures showed a 54% mortality risk reduction.
  
  
  CONCLUSIONS
  S1 predicted mortality in hemodialysis patients. However, better attainment of classical clinical performance measures significantly improved long-term outcome in hemodialysis patients despite their pronounced increase in arterial stiffness.
authors.affiliation: Medizinische Klinik, Nephrologie, Charité Campus Benjamin Franklin, Berlin, Germany.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Scholze
authors.forename: Christina
authors.initials: C
authors.lastname: Thies
authors.forename: Mohamed
authors.initials: M
authors.lastname: Cheikhalfraj
authors.forename: Antje
authors.initials: A
authors.lastname: Wittstock
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Pommer
authors.forename: Walter
authors.initials: W
authors.lastname: Zidek
authors.forename: Martin
authors.initials: M
authors.lastname: Tepel
mesh_terms: D000368:Aged; D000418:Albumins / Q000378:metabolism; D004548:Elasticity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000097:blood / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011446:Prospective Studies; D017534:Radial Artery / Q000503:physiopathology*; D006435:Renal Dialysis / Q000592:standards*; D012307:Risk Factors
chemical_list: D000418:Albumins; D006454:Hemoglobins