Cf-PWV but not cr-PWV or cd-PWV is associated with cardiovascular mortality in patients with chronic kidney disease

In patients with chronic kidney disease (CKD), it is revealed that carotid-femoral pulse wave velocity (cf-PWV) is related to cardiovascular (CV) mortality, but few studies have investigated carotid-radial PWV (cr-PWV) and carotid-dorsalis pedis PWV (cd-PWV). This study aims at examining the relationship between cf-PWV, cr-PWV, and cd-PWV and CV mortality in CKD patients.

We enrolled non-dialysis CKD patients with an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m². Baseline arterial stiffness was assessed through office-based measurements of cf-PWV, cr-PWV, and cd-PWV using standardized protocols. Participants were then prospectively followed for all-cause mortality and CV mortality. Cox proportional hazards model and Fine-Gray competing risk model was used to examine the association of cf-PWV, cr-PWV, and cd-PWV with all-cause and CV mortality. Time-dependent receiver operating characteristic (ROC) curve was used to evaluate the predicting performance of cf-PWV on CV mortality.

A total of 233 patients were enrolled. Their average cf-PWV, cr-PWV, and cd-PWV were 12.8 ± 3.6 m/s, 9.9 ± 2.0 m/s, and 9.4 ± 3.7 m/s, respectively. During 9.0(4.0, 12.6) years of follow-up, 144 (61.8%) patients died, of which 76 (52.8%) were due to CV death. After adjustment using multivariate Cox regression analysis, only cf-PWV was an independent risk factor for CV mortality [HR 1.198,95% CI (1.097, 1.308)]. The areas under the curve of cf-PWV for 1-, 3-, 5-, and 10-year of CV death were 0.78, 0.76, 0.70, and 0.75, respectively.

In CKD patients, cf-PWV is associated with CV mortality, and its predictive value remains significant even after 10 years. Cr-PWV and cd-PWV are not associated with either all-cause or CV mortality.