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Updated: Jun 20, 2026

Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Arterial stiffness in hemodialysis: which parameter to measure to predict cardiovascular mortality?
Taha El Hadj Othmane1, János Nemcsik, Bertalan Cs Fekete
11st Department of Medicine, Semmelweis University Budapest, Budapest, Hungary. tahaothmane@yahoo.com
Insights
Arterial stiffness parameters like pulse wave velocity (PWV) and pulse pressure amplification (AMP) predict cardiovascular death in hemodialysis patients. PWV is consistently linked to mortality, while predialysis AMP offers additional prognostic value.
Area of Science:
- Nephrology
- Cardiology
- Vascular Biology
Background:
- Arterial stiffness is linked to cardiovascular mortality in hemodialysis patients.
- The relative prognostic value of different arterial stiffness parameters is not well-established in a single cohort.
Purpose of the Study:
- To evaluate the prognostic value of carotid-femoral pulse wave velocity (PWV), carotid augmentation index, carotid pulse pressure (CPP), and carotid-brachial pulse pressure amplification (AMP) for cardiovascular mortality in hemodialysis patients.
- To compare the predictive power of these arterial stiffness parameters within a single cohort.
Main Methods:
- Ninety-eight hemodialysis patients had arterial stiffness parameters measured before and after hemodialysis.
- Patients were followed for a median of 29 months for cardiovascular mortality.
- Statistical analysis included log-rank tests and Cox proportional hazards regressions.
Main Results:
- Increasing predialysis and postdialysis PWV tertiles were significantly associated with cardiovascular mortality (p=0.012 and p=0.011).
- Decreasing predialysis AMP tertiles were significantly associated with cardiovascular mortality (p<0.001).
- Carotid augmentation index and carotid pulse pressure were not significantly related to cardiovascular mortality.
Conclusions:
- Pulse wave velocity (PWV) is a consistent predictor of cardiovascular mortality in hemodialysis patients, regardless of measurement timing.
- Predialysis carotid-brachial pulse pressure amplification (AMP) provides additional prognostic information beyond PWV.
- PWV and predialysis AMP are independently associated with cardiovascular mortality in this cohort.
Abstract:
In previous studies, different parameters of arterial stiffness were related to cardiovascular mortality in hemodialysis patients, but their relative prognostic value has not previously been evaluated in 1 cohort. Carotid-femoral pulse wave velocity (PWV), the carotid augmentation index, carotid pulse pressure (CPP) and carotid-brachial pulse pressure amplification (AMP) were measured in 98 patients before and after hemodialysis. Patients were followed for a median of 29 months (1-34) and the association of these parameters with cardiovascular mortality were assessed using log-rank tests and Cox proportional hazards regressions. During follow-up, 25 patients died of cardiovascular causes. Increasing pre- and postdialysis PWV tertiles and decreasing predialysis AMP tertiles were significantly related to cardiovascular mortality (p = 0.012 and 0.011 for PWV, respectively; < 0.001 for AMP). Neither the carotid augmentation index nor carotid pulse pressure were related to cardiovascular mortality. The adjusted hazard ratios for 1 m/s higher pre- and postdialysis PWV were 1.24 (1.07-1.44) and 1.17 (1.06-1.28), respectively. The hazard ratio for 10% lower predialysis AMP was 1.41 (1.03-1.92). When included in the same model, both predialysis PWV and AMP remained significantly associated with cardiovascular mortality. Among different stiffness parameters, PWV is consistently related to cardiovascular mortality, irrespective of the timing of measurement. Predialysis AMP seems to provide additional prognostic information.
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Preparation:
