title: Aortic-brachial stiffness mismatch and mortality in dialysis population.
abstract: We hypothesized that increased aortic stiffness (central elastic artery) combined with a decrease in brachial stiffness (peripheral muscular artery) leads to the reversal of the physiological stiffness gradient (ie, mismatch), promoting end-organ damages through increased forward pressure wave transmission into the microcirculation. We, therefore, examined the effect of aortic-brachial stiffness mismatch on mortality in patients in need of dialysis. In a prospective observational study, aortic-brachial arterial stiffness mismatch (pulse wave velocity ratio) was assessed using carotid-femoral pulse wave velocity divided by carotid-radial pulse wave velocity in 310 adult patients on dialysis. After a median follow-up of 29 months, 146 (47%) deaths occurred. The hazard ratio (HR) for mortality related to PWV ratio in a Cox regression analysis was 1.43 (95% confidence interval [CI], 1.24-1.64; P<0.001 per 1 SD) and was still significant after adjustments for confounding factors, such as age, dialysis vintage, sex, cardiovascular disease, diabetes mellitus, smoking status, and weight (HR, 1.23; 95% CI: 1.02-1.49). The HRs for changes in 1 SD of augmentation index (HR, 1.35; 95% CI, 1.12-1.63), carotid-femoral pulse wave velocity (HR, 1.29; 95% CI, 1.11-1.50), and carotid-radial pulse wave velocity (HR, 0.80; 95% CI, 0.67-0.95) were statistically significant in univariate analysis, but were no longer statistically significant after adjustment for age. In conclusion, aortic-brachial arterial stiffness mismatch was strongly and independently associated with increased mortality in this dialysis population. Further studies are required to confirm these finding in lower-risk groups.
authors.affiliation: From the CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Division of Nephrology, Faculty of Medicine, Université Laval, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Université Paris Descartes, Paris, France (P.B.); Department of Pharmacology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France (P.B.); and Institut National de la Santé et de la Recherche Médicale, U970-PARCC, France (P.B.).
authors.forename: Catherine
authors.initials: C
authors.lastname: Fortier
authors.affiliation: From the CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Division of Nephrology, Faculty of Medicine, Université Laval, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Université Paris Descartes, Paris, France (P.B.); Department of Pharmacology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France (P.B.); and Institut National de la Santé et de la Recherche Médicale, U970-PARCC, France (P.B.).
authors.forename: Fabrice
authors.initials: F
authors.lastname: Mac-Way
authors.affiliation: From the CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Division of Nephrology, Faculty of Medicine, Université Laval, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Université Paris Descartes, Paris, France (P.B.); Department of Pharmacology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France (P.B.); and Institut National de la Santé et de la Recherche Médicale, U970-PARCC, France (P.B.).
authors.forename: Simon
authors.initials: S
authors.lastname: Desmeules
authors.affiliation: From the CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Division of Nephrology, Faculty of Medicine, Université Laval, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Université Paris Descartes, Paris, France (P.B.); Department of Pharmacology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France (P.B.); and Institut National de la Santé et de la Recherche Médicale, U970-PARCC, France (P.B.).
authors.forename: Karine
authors.initials: K
authors.lastname: Marquis
authors.affiliation: From the CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Division of Nephrology, Faculty of Medicine, Université Laval, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Université Paris Descartes, Paris, France (P.B.); Department of Pharmacology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France (P.B.); and Institut National de la Santé et de la Recherche Médicale, U970-PARCC, France (P.B.).
authors.forename: Sacha A
authors.initials: SA
authors.lastname: De Serres
authors.affiliation: From the CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Division of Nephrology, Faculty of Medicine, Université Laval, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Université Paris Descartes, Paris, France (P.B.); Department of Pharmacology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France (P.B.); and Institut National de la Santé et de la Recherche Médicale, U970-PARCC, France (P.B.).
authors.forename: Marcel
authors.initials: M
authors.lastname: Lebel
authors.affiliation: From the CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Division of Nephrology, Faculty of Medicine, Université Laval, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Université Paris Descartes, Paris, France (P.B.); Department of Pharmacology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France (P.B.); and Institut National de la Santé et de la Recherche Médicale, U970-PARCC, France (P.B.).
authors.forename: Pierre
authors.initials: P
authors.lastname: Boutouyrie
authors.affiliation: From the CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Division of Nephrology, Faculty of Medicine, Université Laval, Québec, Québec, Canada (C.F., F.M., S.D., K.M., S.A.D.S., M.L., M.A.); Université Paris Descartes, Paris, France (P.B.); Department of Pharmacology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France (P.B.); and Institut National de la Santé et de la Recherche Médicale, U970-PARCC, France (P.B.). Mohsen.Agharazii@crhdq.ulaval.ca.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Agharazii
mesh_terms: D000367:Age Factors; D000368:Aged; D001916:Brachial Artery; D002339:Carotid Arteries; D015897:Comorbidity; D015986:Confounding Factors, Epidemiologic; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000453:epidemiology; D010530:Peritoneal Dialysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D063177:Pulse Wave Analysis; D017534:Radial Artery; D006435:Renal Dialysis; D059289:Vascular Stiffness
keywords: aortic stiffness; arterial stiffness; chronic kidney disease; dialysis; pulse wave analysis; pulse wave velocity