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High Pulse-Wave Velocity Defines a Very High Cardiovascular Risk Cohort of Dialysis Patients under Age 60.
Am J Nephrol. 2017; 45(1):72-81.AJ

Abstract

BACKGROUND

Patients with end-stage renal disease (ESRD) are at a high risk of cardiovascular mortality (CVM). In patients with ESRD, arterial stiffness increases at an earlier age when compared to the general population and this contributes to the overall risk of cardiovascular mortality. The main objective of this study was to clarify the interplay between age and cardiovascular alterations in ESRD.

METHODS

Prospective, observational cohort study initiated in April 1987 until the end of 1998 with events recorded until the end of the year 2000 at the F.H. Manhes Hospital Center, Fleury-Mérogis (in the Paris/Ile de France area).

RESULTS

The study population consisted of 278 ESRD patients undergoing dialysis therapy. The mean ± SD age was 53 ± 16 years. The mean pulse-wave velocity (PWV) was ∼11 m/s, with ∼37% of patients having a PWV >12 m/s. During the follow-up period, 91 patients died from CV causes. PWV >12 m/s was associated with CVM in the unadjusted model but lost its prognostic value in patients >60 years (p for interaction = 0.008). In patients ≤60 years, PWV was found to be a strong and independent predictor of CVM with hazards ratio (95% CI) of 14.382 (7.120-29.047), p < 0.001, and it improved the prognostic reclassification of a model containing well-established prognostic variables. According to multivariable regression analysis, aortic PWV was strongly associated with age (R2 = 0.37, p < 0.001).

CONCLUSION

A PWV >12 m/s provides important prognostic information in ESRD patients under 60 years of age, whereas in older patients, its prognostic relevance is lost. These findings are of critical relevance for early intervention guidance and trial end-point/treatment effect interpretation.

Authors+Show Affiliations

INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, CHRU de Nancy, Nancy, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

27898419

Citation

Ferreira, João Pedro, et al. "High Pulse-Wave Velocity Defines a Very High Cardiovascular Risk Cohort of Dialysis Patients Under Age 60." American Journal of Nephrology, vol. 45, no. 1, 2017, pp. 72-81.
Ferreira JP, Girerd N, Pannier B, et al. High Pulse-Wave Velocity Defines a Very High Cardiovascular Risk Cohort of Dialysis Patients under Age 60. Am J Nephrol. 2017;45(1):72-81.
Ferreira, J. P., Girerd, N., Pannier, B., Rossignol, P., & London, G. M. (2017). High Pulse-Wave Velocity Defines a Very High Cardiovascular Risk Cohort of Dialysis Patients under Age 60. American Journal of Nephrology, 45(1), 72-81. https://doi.org/10.1159/000453338
Ferreira JP, et al. High Pulse-Wave Velocity Defines a Very High Cardiovascular Risk Cohort of Dialysis Patients Under Age 60. Am J Nephrol. 2017;45(1):72-81. PubMed PMID: 27898419.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High Pulse-Wave Velocity Defines a Very High Cardiovascular Risk Cohort of Dialysis Patients under Age 60. AU - Ferreira,João Pedro, AU - Girerd,Nicolas, AU - Pannier,Bruno, AU - Rossignol,Patrick, AU - London,Gerard M, Y1 - 2016/11/30/ PY - 2016/08/12/received PY - 2016/09/15/accepted PY - 2016/11/30/pubmed PY - 2018/1/11/medline PY - 2016/11/30/entrez SP - 72 EP - 81 JF - American journal of nephrology JO - Am J Nephrol VL - 45 IS - 1 N2 - BACKGROUND: Patients with end-stage renal disease (ESRD) are at a high risk of cardiovascular mortality (CVM). In patients with ESRD, arterial stiffness increases at an earlier age when compared to the general population and this contributes to the overall risk of cardiovascular mortality. The main objective of this study was to clarify the interplay between age and cardiovascular alterations in ESRD. METHODS: Prospective, observational cohort study initiated in April 1987 until the end of 1998 with events recorded until the end of the year 2000 at the F.H. Manhes Hospital Center, Fleury-Mérogis (in the Paris/Ile de France area). RESULTS: The study population consisted of 278 ESRD patients undergoing dialysis therapy. The mean ± SD age was 53 ± 16 years. The mean pulse-wave velocity (PWV) was ∼11 m/s, with ∼37% of patients having a PWV >12 m/s. During the follow-up period, 91 patients died from CV causes. PWV >12 m/s was associated with CVM in the unadjusted model but lost its prognostic value in patients >60 years (p for interaction = 0.008). In patients ≤60 years, PWV was found to be a strong and independent predictor of CVM with hazards ratio (95% CI) of 14.382 (7.120-29.047), p < 0.001, and it improved the prognostic reclassification of a model containing well-established prognostic variables. According to multivariable regression analysis, aortic PWV was strongly associated with age (R2 = 0.37, p < 0.001). CONCLUSION: A PWV >12 m/s provides important prognostic information in ESRD patients under 60 years of age, whereas in older patients, its prognostic relevance is lost. These findings are of critical relevance for early intervention guidance and trial end-point/treatment effect interpretation. SN - 1421-9670 UR - https://www.unboundmedicine.com/medline/citation/27898419/High_Pulse_Wave_Velocity_Defines_a_Very_High_Cardiovascular_Risk_Cohort_of_Dialysis_Patients_under_Age_60_ L2 - https://www.karger.com?DOI=10.1159/000453338 DB - PRIME DP - Unbound Medicine ER -