Aortic-brachial stiffness mismatch and mortality in dialysis population

We hypothesized that increased aortic stiffness (central elastic artery) combined with a decrease in brachial stiffness (peripheral muscular artery) leads to the reversal of the physiological stiffness gradient (ie, mismatch), promoting end-organ damages through increased forward pressure wave trans...

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Veröffentlicht in:Hypertension (Dallas, Tex. 1979) Jg. 65; H. 2; S. 378
Hauptverfasser: Fortier, Catherine, Mac-Way, Fabrice, Desmeules, Simon, Marquis, Karine, De Serres, Sacha A, Lebel, Marcel, Boutouyrie, Pierre, Agharazii, Mohsen
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States 01.02.2015
Schlagworte:
Age Factors
Aged
Brachial Artery
Carotid Arteries
Comorbidity
Confounding Factors (Epidemiology)
Diabetes Mellitus - epidemiology
Female
Femoral Artery
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Kidney Failure, Chronic - mortality
Kidney Failure, Chronic - physiopathology
Kidney Failure, Chronic - therapy
Male
Middle Aged
Overweight - epidemiology
Peritoneal Dialysis
Prognosis
Proportional Hazards Models
Prospective Studies
Pulse Wave Analysis
Radial Artery
Renal Dialysis
Vascular Stiffness
arterial stiffness
dialysis
chronic kidney disease
aortic stiffness
pulse wave velocity
pulse wave analysis
ISSN:1524-4563, 1524-4563
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Zusammenfassung:We hypothesized that increased aortic stiffness (central elastic artery) combined with a decrease in brachial stiffness (peripheral muscular artery) leads to the reversal of the physiological stiffness gradient (ie, mismatch), promoting end-organ damages through increased forward pressure wave transmission into the microcirculation. We, therefore, examined the effect of aortic-brachial stiffness mismatch on mortality in patients in need of dialysis. In a prospective observational study, aortic-brachial arterial stiffness mismatch (pulse wave velocity ratio) was assessed using carotid-femoral pulse wave velocity divided by carotid-radial pulse wave velocity in 310 adult patients on dialysis. After a median follow-up of 29 months, 146 (47%) deaths occurred. The hazard ratio (HR) for mortality related to PWV ratio in a Cox regression analysis was 1.43 (95% confidence interval [CI], 1.24-1.64; P<0.001 per 1 SD) and was still significant after adjustments for confounding factors, such as age, dialysis vintage, sex, cardiovascular disease, diabetes mellitus, smoking status, and weight (HR, 1.23; 95% CI: 1.02-1.49). The HRs for changes in 1 SD of augmentation index (HR, 1.35; 95% CI, 1.12-1.63), carotid-femoral pulse wave velocity (HR, 1.29; 95% CI, 1.11-1.50), and carotid-radial pulse wave velocity (HR, 0.80; 95% CI, 0.67-0.95) were statistically significant in univariate analysis, but were no longer statistically significant after adjustment for age. In conclusion, aortic-brachial arterial stiffness mismatch was strongly and independently associated with increased mortality in this dialysis population. Further studies are required to confirm these finding in lower-risk groups.
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ISSN:1524-4563
1524-4563
DOI:10.1161/HYPERTENSIONAHA.114.04587