Arterial stiffness in hemodialysis: which parameter to measure to predict cardiovascular mortality?
In previous studies, different parameters of arterial stiffness were related to cardiovascular mortality in hemodialysis patients, but their relative prognostic value has not previously been evaluated in 1 cohort. Carotid-femoral pulse wave velocity (PWV), the carotid augmentation index, carotid pulse pressure (CPP) and carotid-brachial pulse pressure amplification (AMP) were measured in 98 patients before and after hemodialysis. Patients were followed for a median of 29 months (1-34) and the association of these parameters with cardiovascular mortality were assessed using log-rank tests and Cox proportional hazards regressions. During follow-up, 25 patients died of cardiovascular causes. Increasing pre- and postdialysis PWV tertiles and decreasing predialysis AMP tertiles were significantly related to cardiovascular mortality (p = 0.012 and 0.011 for PWV, respectively; < 0.001 for AMP). Neither the carotid augmentation index nor carotid pulse pressure were related to cardiovascular mortality. The adjusted hazard ratios for 1 m/s higher pre- and postdialysis PWV were 1.24 (1.07-1.44) and 1.17 (1.06-1.28), respectively. The hazard ratio for 10% lower predialysis AMP was 1.41 (1.03-1.92). When included in the same model, both predialysis PWV and AMP remained significantly associated with cardiovascular mortality. Among different stiffness parameters, PWV is consistently related to cardiovascular mortality, irrespective of the timing of measurement. Predialysis AMP seems to provide additional prognostic information.
Othmane
Taha El Hadj
Tel H
1st Department of Medicine, Semmelweis University Budapest, Budapest, Hungary. tahaothmane@yahoo.com
Nemcsik
János
J
Fekete
Bertalan Cs
BC
Deák
György
G
Egresits
József
J
Fodor
Erzsébet
E
Logan
Alexander G
AG
Németh
Zsófia K
ZK
Járai
Zoltán
Z
Szabó
Tamás
T
Szathmári
Miklós
M
Kiss
István
I
Tislér
András
A
D000368:Aged; D055109:Ankle Brachial Index; D001158:Arteries / Q000473:pathology*; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality*; D002339:Carotid Arteries / Q000503:physiopathology; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009129:Muscle Tonus / Q000502:physiology; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012039:Regional Blood Flow / Q000502:physiology; D006435:Renal Dialysis / Q000009:adverse effects*; D016019:Survival Analysis