Comparison of 24-hour and Office Pulse Wave Velocity for Prediction of Mortality in Hemodialysis Patients

Julia Matschkal, Christopher C. Mayer, Pantelis A. Sarafidis, Georg Lorenz, Matthias C. Braunisch, Roman Guenthner, Susanne Angermann, Dominik Steubl, Stephan Kemmner, Quirin Bachmann, Christine Hauser, Louisa Nerl, Marcus Baumann, Johannes F. Mann, Philipp Moog, Claudius Kuechle, Lutz Renders, Uwe Heemann, Siegfried Wassertheurer, Christoph Schmaderer

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25 Scopus citations

Abstract

Mortality in hemodialysis patients still remains unacceptably high. Enhanced arterial stiffness is a known cardiovascular risk factor, and pulse wave velocity (PWV) has proven to be a valid parameter to quantify risk. Recent studies showed controversial results regarding the prognostic significance of PWV for mortality in hemodialysis patients, which may be due to methodological issues, such as assessment of PWV in the office setting (Office-PWV). >bold<>italic<Method:>/italic<>/bold< This study cohort contains patients from the "Risk stratification in end-stage renal disease - the ISAR study," a multicenter prospective longitudinal observatory cohort study. We examined and compared the predictive value of ambulatory 24-hour PWV (24 h-PWV) and Office-PWV on mortality in a total of 344 hemodialysis patients. The endpoints of the study were all-cause and cardiovascular mortality. Survival analysis included Kaplan-Meier estimates and Cox regression analysis. >bold<>italic<Results:>/italic<>/bold< During a follow-up of 36 months, a total of 89 patients died, 35 patients due to cardiovascular cause. Kaplan-Meier estimates for tertiles of 24 h-PWV and Office-PWV were similarly associated with mortality. In univariate Cox regression analysis, 24 h-PWV and Office-PWV were equivalent predictors for all-cause and cardiovascular mortality. After adjustment for common risk factors, only 24 h-PWV remained solely predictive for all-cause mortality (hazard ratio 2.51 [95% CI 1.31-4.81]; >italic

/italic< = 0.004). >bold<>italic<Conclusions:>/italic<>/bold< Comparing both measurements, 24 h-PWV is an independent predictor for all-cause-mortality in hemodialysis patients beyond Office-PWV.

Original languageEnglish
Pages (from-to)317-327
Number of pages11
JournalAmerican Journal of Nephrology
Volume49
Issue number4
DOIs
StatePublished - 1 Apr 2019
Externally publishedYes

Keywords

  • Ambulatory blood pressure monitoring
  • Arterial stiffness
  • Chronic hemodialysis
  • Mortality
  • Pulse wave velocity

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