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Increased indexed proximal aortic diameter is a predictor of poor prognosis in maintenance hemodialysis patients

Junwei Xu1, Wenyi Tang1, Lizheng Song1

  • 1Department of Cardiovascular Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, China.

Renal Failure
|May 24, 2024
PubMed

Insights

Absolute aortic root diameter (ARD) predicts mortality and cardiovascular events in patients with end-stage renal disease on maintenance hemodialysis. Measuring ARD can improve risk assessment and prevention strategies for these high-risk patients.

Area of Science:

  • Cardiovascular Medicine
  • Nephrology
  • Echocardiography

Background:

  • Baseline absolute aortic root diameter (ARD) and indexed diameter predict mortality and cardiovascular events in the general population.
  • Limited data exists on the prognostic value of ARD in end-stage renal disease (ESRD) patients undergoing maintenance hemodialysis (MHD).
  • This study investigates ARD's predictive capability for mortality and cardiovascular events in MHD patients.

Purpose of the Study:

  • To determine if baseline absolute aortic root diameter (ARD) indexed to body surface area (BSA) predicts all-cause mortality.
  • To assess the association between baseline ARD/BSA and major adverse cardiovascular events (MACE) in ESRD patients on MHD.

Main Methods:

  • Echocardiography was used to measure ARD at end diastole, indexed to body surface area (BSA).
  • Primary endpoint was all-cause mortality; secondary endpoint was MACE (cardiovascular mortality, myocardial infarction, stroke).
  • Cox proportional hazards models analyzed the association between baseline ARD/BSA and clinical outcomes in 391 patients.

Main Results:

  • 95 patients (24.3%) experienced all-cause mortality, and 71 (18.2%) had MACE.
  • Multivariate analysis revealed ARD/BSA as an independent predictor of all-cause mortality (HR per 1-SD increase: 1.403; p=0.003).
  • ARD/BSA also independently predicted MACE (HR per 1-SD increase: 1.356; p=0.026).

Conclusions:

  • Absolute aortic root diameter indexed to body surface area (ARD/BSA) is a significant predictor of all-cause mortality and MACE in MHD patients with ESRD.
  • Assessment of ARD/BSA may enhance risk stratification for cardiovascular events and mortality in this vulnerable population.
  • These findings support the integration of ARD/BSA measurements into preventive strategies for ESRD patients on MHD.

Keywords:
Aortic root diameterall-cause mortalityechocardiographyend-stage renal diseasemaintenance hemodialysismajor adverse cardiovascular events

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