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Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease
J Blacher1, A P Guerin, B Pannier
1Service de Médecine Interne, Hôpital Broussais, AP-HP, Paris, France. jacques.blacher@brs.ap-hop-paris.fr
Insights
Vascular calcifications and carotid incremental elastic modulus strongly predict mortality in hemodialysis patients. The extent of calcifications and arterial stiffness independently increase death risk, offering crucial prognostic information.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Vascular Biology
Background:
- End-stage renal disease (ESRD) patients on hemodialysis exhibit accelerated vascular aging.
- Arterial stiffness and calcifications are common in ESRD and linked to poor outcomes.
- Predictive value of specific arterial parameters for mortality in this population requires further elucidation.
Purpose of the Study:
- To assess the predictive value of various arterial parameters for cardiovascular and all-cause mortality.
- To determine the independent contributions of arterial wall characteristics and calcifications to mortality risk.
- To explore arterial parameters at multiple vascular sites.
Main Methods:
- Prospective study of 110 stable ESRD patients undergoing hemodialysis.
- Measured parameters included carotid and aortic dimensions, intima-media thickness, compliance, distensibility, incremental elastic modulus, and arterial calcifications (scored 0-4).
- Follow-up of 53 months with recording of cardiovascular and all-cause deaths.
Main Results:
- The carotid incremental elastic modulus was the strongest univariate predictor of mortality.
- Increased risk of death correlated with the number of vascular sites affected by calcifications.
- Both calcification score (HR 1.9 for all-cause, 2.6 for CV mortality per unit increase) and carotid incremental elastic modulus (HR 1.6 for all-cause, 1.7 for CV mortality per SD increase) were independent predictors.
- Carotid incremental elastic modulus provided additive predictive value to calcification assessment.
Conclusions:
- The presence and extent of vascular calcifications are significant predictors of mortality in hemodialysis patients.
- Carotid incremental elastic modulus, reflecting arterial stiffness, independently predicts cardiovascular and all-cause mortality.
- Combining assessments of vascular calcification and arterial stiffness offers enhanced prognostic capability in ESRD patients.
Abstract:
To test the predictive values of and independent contributions to cardiovascular and all-cause mortality of various arterial parameters exploring characteristics of the arterial wall at different sites, we studied prospectively 110 stable end-stage renal disease patients on hemodialysis. These parameters involved carotid diameter, carotid intima-media thickness, carotid compliance, carotid distensibility, carotid incremental elastic modulus, aortic diameter, aortic pulse wave velocity, and the presence of arterial calcifications measured at the sites of the carotid artery, abdominal aorta, iliofemoral axis, and legs. The presence of calcifications was analyzed semiquantitatively as a score (0 to 4) according to the number of arterial sites with calcifications. During a follow-up of 53+/-21 months (mean+/-SD), 25 cardiovascular and 14 noncardiovascular deaths occurred. In univariate analysis, the carotid incremental elastic modulus was the most closely related to prognosis. Risk of death increased with the number of vascular sites involved by calcifications. Moreover, information (in terms of prediction) given by carotid elastic incremental modulus was additive to the presence and extent of vascular calcification-related prediction value. Adjusted hazard ratios of all-cause and cardiovascular mortality for an increase of 1 unit in calcification score were 1.9 (95% confidence interval [CI], 1.4 to 2.6) and 2.6 (95% CI, 1.5 to 4.4), respectively (P<0.001 for both). Adjusted hazard ratios of all-cause and cardiovascular mortality for a 1-SD increase in carotid incremental elastic modulus were 1.6 (95% CI, 1.2 to 2.2) and 1.7 (95% CI, 1.2 to 2.4), respectively (P<0.01 for both). The results of this study showed that the presence and extent of vascular calcifications were strong predictors of cardiovascular and all-cause mortality. Carotid incremental elastic modulus gave additional predictive value.