title: Impact of arterial stiffness on adverse cardiovascular outcomes and mortality in peritoneal dialysis patients.
abstract: BACKGROUND
  Cardiovascular (CV) disease is a major cause of morbidity and mortality in patients with end-stage renal disease. In recent years, arterial stiffness has taken on great importance in the pathophysiology of CV diseases. The independent predictive value of arterial stiffness for CV events and for all-cause and CV mortality has been demonstrated in the general population and in hemodialysis patients. Our aim in this study was to determine the relationship of arterial stiffness with mortality and fatal and nonfatal CV events in peritoneal dialysis (PD) patients.
  
  
  METHODS
  In this prospective observational cohort study with 2 years of follow-up, we studied a cohort of 156 PD patients with a mean follow-up of 19.2 ± 6.4 months. At baseline, echocardiography and standard clinical and biochemical analyses were performed in all patients and in 28 healthy subjects. Aortic stiffness index beta (ASIβ, a surrogate marker of arterial stiffness) was calculated as follows: ASIβ = ln (systolic blood pressure / diastolic blood pressure) / [(systolic diameter – diastolic diameter) / diastolic diameter].
  
  
  RESULTS
  During the follow-up period, 25 of the patients (16.0%) died, and 10 of those deaths had CV causes. Nonfatal CV events occurred in 15 patients. The median ASIβ was greater in PD patients than in control subjects (4.2 vs. 3.5; interquartile range: 3.2 - 5.5 vs. 2.5 - 4.8; p = 0.028]. In the fully adjusted multivariate Cox regression analysis (co-variates: age, sex, albumin, hemoglobin, diabetes mellitus, comorbid CV disease, left ventricular mass index, residual glomerular filtration rate, dialysate-to-plasma ratio of creatinine, Kt/V urea, left ventricular ejection fraction, duration of dialysis, smoking), ASIβ independently predicted fatal and nonfatal CV events (hazard ratio: 1.239; 95% confidence interval: 1.103 to 1.392), but not all-cause mortality.
  
  
  CONCLUSIONS
  Our results provide the first direct evidence that arterial stiffness is an independent risk predictor of adverse CV outcome in PD patients.
authors: Department of Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey. murathsipahioglu@yahoo.com
authors: Murat H
authors: MH
authors: Sipahioglu
authors: Hamit
authors: H
authors: Kucuk
authors: Aydin
authors: A
authors: Unal
authors: Mehmet G
authors: MG
authors: Kaya
authors: Fatih
authors: F
authors: Oguz
authors: Bulent
authors: B
authors: Tokgoz
authors: Oktay
authors: O
authors: Oymak
authors: Cengiz
authors: C
authors: Utas
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D014421:Turkey / Q000453:epidemiology; D014655:Vascular Resistance