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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Measures of wave intensity as a non-invasive surrogate for cardiac function predicts mortality in haemodialysis
Christopher C Mayer1,2, Pantelis A Sarafidis3, Julia Matschkal4
1AIT Austrian Institute of Technology, Center for Health & Bioresources, Medical Signal Analysis, Vienna, Austria.
Insights
A new systolic function index (SDR) predicts mortality in haemodialysis patients. This non-invasive measure also correlates with fluid removal during dialysis, offering insights into cardiovascular risk.
Area of Science:
- Nephrology
- Cardiology
- Biomedical Engineering
Background:
- Risk prediction in haemodialysis (HD) patients is complex due to fluid status, cardiac function, and comorbidities.
- Assessing cardiac function, a key predictor of cardiovascular (CV) mortality, is challenging in routine HD care.
Purpose of the Study:
- To investigate the association of a novel, non-invasive systolic function index with mortality in HD patients.
- To assess the interplay between this index and volume removal during dialysis.
Main Methods:
- Analysis of 558 HD patients (median age 66 years) with 24-hour ambulatory blood pressure monitoring.
- Inclusion of wave intensity analysis, specifically the S:D ratio (SDR), as a novel index.
- Utilized multivariate proportional hazards models for risk prediction with all-cause and CV mortality as endpoints.
Main Results:
- The SDR was significantly associated with both all-cause (HR 1.36) and CV mortality (HR 1.41) in univariate and multivariate analyses.
- Changes in SDR from pre- to post-dialysis varied significantly across different ultrafiltration volume groups.
- The study included 373 males and 185 females, with 193 deaths (92 CV) over 37.8 months.
Conclusions:
- The study provides strong evidence for the independent association of the SDR, a novel index of systolic function, with mortality in HD patients.
- Significant association found between intradialytic changes in SDR and the volume of fluid removed during dialysis.
Background:
Risk prediction in haemodialysis (HD) patients is challenging due to the impact of the dialysis regime on the patient's volume status and the complex interplay with cardiac function, comorbidities and hypertension. Cardiac function as a key predictor of cardiovascular (CV) mortality in HD patients is challenging to assess in daily routine. Thus the aim of this study was to investigate the association of a novel, non-invasive relative index of systolic function with mortality and to assess its interplay with volume removal.
Methods:
A total of 558 (373 male/185 female) HD patients with a median age of 66 years were included in this analysis. They underwent 24-hour ambulatory blood pressure monitoring, including wave intensity analysis [i.e. S:D ratio (SDR)]. All-cause and CV mortality served as endpoints and multivariate proportional hazards models were used for risk prediction. Intradialytic changes were analysed in tertiles according to ultrafiltration volume. During a follow-up of 37.8 months, 193 patients died (92 due to CV reasons).
Results:
The SDR was significantly associated with all-cause {univariate hazard ratio [HR] 1.36 [95% confidence interval (CI) 1.20-1.54], P < .001} and CV [univariate HR 1.41 (95% CI 1.20-1.67), P < .001] mortality. The associations remained significant in multivariate analysis accounting for possible confounders. Changes in the SDR from pre-/early- to post-dialytic averages were significantly different for the three ultrafiltration volume groups.
Conclusion:
This study provides well-powered evidence for the independent association of a novel index of systolic function with mortality. Furthermore, it revealed a significant association between intradialytic changes of the measure and intradialytic volume removal.
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