title: Determinants of progression of aortic stiffness in hemodialysis patients: a prospective longitudinal study.
abstract: Aortic stiffness is associated with increased cardiovascular mortality in patients with chronic kidney disease. However, the rate of progression of arterial stiffness and the role of cardiovascular risk factors in the progression of arterial stiffness has never been established in a longitudinal study. In a prospective, longitudinal, observational study, carotid-femoral pulse wave velocity and carotid-radial pulse wave velocity were assessed in 109 hemodialysis patients at baseline and after a mean follow-up of 1.2 years. We examined the impact of age, atherosclerotic cardiovascular disease, diabetes mellitus, dialysis vintage, and pentosidine (a well-characterized, advanced glycation end products) on the rate of progression of aortic stiffness. The annual rate of changes in carotid-femoral pulse wave velocity and carotid-radial pulse wave velocity were 0.84 m/s per year (95% confidence interval, 0.50-1.12 m/s per year) and -0.66 m/s per year (95% confidence interval, -0.85 to -0.47 m/s per year), respectively. Older subjects, and patients with diabetes mellitus or atherosclerotic cardiovascular disease had higher aortic stiffness at baseline, however, the rate of progression of aortic stiffness was only determined by plasma pentosidine levels (P=0.001). The degree of baseline aortic stiffness was a significant determinant of the regression of brachial stiffness (P<0.001) suggesting that the regression of brachial stiffness occurs in response to central aortic stiffness. These findings suggest that traditional cardiovascular risk factors may play some role in the progression of aortic stiffness before development of advanced chronic kidney disease, and that the enhanced rate of progression of aortic stiffness in chronic kidney disease patients on dialysis are probably determined by more specific chronic kidney disease-related risk factors such as advanced-glycation end products.
authors: CHU de Québec Research Center, L’Hôtel Dieu de Québec Hospital Quebec, Quebec, Canada.
authors: Mihai S
authors: MS
authors: Utescu
authors: Véronique
authors: V
authors: Couture
authors: Fabrice
authors: F
authors: Mac-Way
authors: Sacha A
authors: SA
authors: De Serres
authors: Karine
authors: K
authors: Marquis
authors: Richard
authors: R
authors: Larivière
authors: Simon
authors: S
authors: Desmeules
authors: Marcel
authors: M
authors: Lebel
authors: Pierre
authors: P
authors: Boutouyrie
authors: Mohsen
authors: M
authors: Agharazii
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011792:Quebec / Q000453:epidemiology; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D059289:Vascular Stiffness
keywords: advanced-glycation end products; aortic stiffness; brachial stiffness; chronic kidney disease; hemodialysis; pulse wave velocity