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Published on: October 2, 2020
Arterial wave reflections and mortality in haemodialysis patients--only relevant in elderly, cardiovascularly
Adrian Covic1, Nicoleta Mardare, Paul Gusbeth-Tatomir
1Dialysis and Transplantation Center, C. I. PARHON University Hospital, 50 Carol 1st Blvd., Iasi, 700503 Romania. acovic@xnet.ro
Insights
Arterial stiffness markers like augmentation index (AIx) do not predict mortality in young, non-diabetic dialysis patients. Patient age and comorbidities, not AIx, were independent predictors of death in this group.
Area of Science:
- Cardiovascular Science
- Nephrology
- Biomedical Engineering
Background:
- Chronic kidney disease (CKD) significantly increases mortality risk, especially in younger individuals.
- Aortic stiffness markers, including augmentation index (AIx), are linked to mortality in end-stage renal disease (ESRD) populations.
- This study investigates arterial stiffness in a specific ESRD subgroup: young, non-diabetic patients with minimal cardiovascular disease.
Purpose of the Study:
- To confirm the detrimental impact of arterial stiffness in uremic patients.
- To evaluate the influence of elevated AIx on survival in a young, non-diabetic dialysis population.
- To assess AIx as an independent predictor of mortality in this carefully selected cohort.
Main Methods:
- Ninety-two non-diabetic ESRD patients (mean age 42.6 years) with minimal prior cardiovascular disease were studied.
- Augmentation index (AIx) was measured using applanation tonometry over a mean follow-up of 61 months.
- Statistical analyses included univariate and stepwise multiple regression, and Cox proportional hazards models.
Main Results:
- Mean AIx was 19.9%. Independent predictors of AIx included weight, systolic blood pressure, and hemoglobin levels.
- During follow-up, age, left ventricular mass index, and ACE-inhibitor therapy were independent predictors of all-cause mortality.
- AIx did not reach statistical significance as a predictor of mortality, and survival did not differ between AIx tertiles.
Conclusions:
- Increased AIx is not a strong independent predictor of mortality in young, non-diabetic ESRD patients on hemodialysis.
- The prognostic value of arterial wave reflections may depend on patient age and the presence of comorbidities.
- Further research is needed to clarify the role of arterial stiffness in diverse CKD populations.
Background:
Chronic kidney disease (CKD) patients have a 3-30-fold increased risk of death compared with the general population. This mortality difference is even more pronounced in younger subjects. Two markers of aortic stiffness--aortic pulse wave velocity (PWV) and augmentation index (AIx)--have been prospectively related to all-cause and cardiovascular (CV) mortality in end-stage renal disease (ESRD) populations. The aims of our study were first, to confirm the important deleterious effect of arterial stiffness in uraemia and second, to assess the impact on survival of increased AIx in a relatively young non-diabetic dialysis population, with minimal CV disease.
Methods:
Ninety-two patients (mean age 42.6 +/- 11.2 years) were included in the study and followed for a period of 61 +/- 25 months. None of the patients had diabetes mellitus, and only 3.3% had prior history of CV disease. AIx was determined by applantation tonometry using a SphygmoCor device (AtCor, PWV Inc., Westmead, Sydney, Australia).
Results:
Mean AIx in our study population was 19.9 +/- 13.7%; other significant haemodynamic parameters were: systolic blood pressure (SBP) 129 +/- 24 mmHg, pulse pressure 35.3 +/- 17.5 mmHg with 27.2% of the study population receiving angiotensin-converting enzyme inhibitors (ACE-I). On univariate analysis, in our group AIx correlated with: body weight (P < 0.001), radial SBP (P < 0.001) and haemoglobin levels (P < 0.05). There was no correlation between AIx and any of the echocardiographic parameters. In the stepwise multiple regression analysis, the only independent predictors for AIx were weight (P < 0.001), SBP (P < 0.001) and haemoglobin (P < 0.05) with the model explaining 33% of the AIx variability (adjusted R(2) = 0.33). During the follow-up period, 15 deaths were recorded. In the Cox analysis (P = 0.014; chi square 20.7 for the model) the only independent predictors for all-cause mortality were age (P = 0.001), left ventricular mass index (P = 0.032) and ACE-I therapy (P = 0.039) while AIx did not reach statistical significance. There was no difference in patients' survival when divided by AIx tertiles, assessed by the log rank test (P = 0.78).
Conclusion:
Our results fail to support the notion that an increased effect of wave reflections on central arteries is a strong and independent predictor of mortality in all ESRD patients on haemodialysis. The effect of arterial wave reflections might be in fact dependent on patient age and concurrent comorbidity status.
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