J Korean Med Sci.  2009 Jan;24(Suppl 1):S121-S128. 10.3346/jkms.2009.24.S1.S121.

The Impact of the Aortic Pulse Wave Velocity on the Cardiovascular Outcomes of Hemodialysis Patients

• Shin SJ
• Kim YK
• Chung S
• Chung HW
• Ihm SH
• Park CW
• Kim YO
• Song HC
• Kim YS
• Choi EJ

• KMID: 1778151
• DOI: http://doi.org/10.3346/jkms.2009.24.S1.S121

Abstract

The aims of our study were to identify the risk factors for an increased aortic pulse wave velocity (AoPWV) and to assess the impact of the AoPWV on the cerebro-cardiovascular (CV) outcomes of hemodialysis (HD) patients. Seventy two HD patients were included, and the AoPWV, the echocardiography and the biochemical parameters were measured. After dividing the patients into tertiles according to the AoPWV values, we defined the low, the middle and the high AoPWV groups. The patients in the high AoPWV group showed a significantly higher age and high-sensitivity C-reactive protein level, a greater prevalence of diabetes and statin use, left ventricular hypertrophy, average pulse pressure (PP), AoPWV and left ventricular mass index and a lower serum albumin level than those in the low AoPWV group (p<0.05). On multivariate regression analysis of the AoPWV, age and the average PP were independently related to the AoPWV (p<0.05). On the multivariate Cox analysis for CV outcomes, the AoPWV and the average PP remained significant independent predictors of CV events. Our data suggest that an increased AoPWV is an independent predictor for the CV outcomes of HD patients.

Keyword

Aortic Pulse Wave Velocity; Aortic Stiffness; Cardiovascular Outcomes; Renal Dialysis

MeSH Terms

Adult
Aged
Albumins/metabolism
Aorta/*pathology
C-Reactive Protein/metabolism
Echocardiography/methods
Female
Heart Rate
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use
Kidney Failure, Chronic/*complications/*therapy
Male
Middle Aged
*Pulse
Renal Dialysis/methods

Figure

• 

  Fig. 1 The relationship between AoPWV and age (A), as well as average pulse pressure (B).

• 

  Fig. 2 Kaplan-Meier survival curves according to the aortic pulse wave subgroups (log rank test; p<0.0001).

Reference

1. Munakata M, Sakuraba J, Tayama J, Furuta T, Yusa A, Nunokawa T, Yoshinaga K, Toyota T. Higher brachial-ankle pulse wave velocity is associated with more advanced carotid atherosclerosis in end-stage renal disease. Hypertens Res. 2005. 28:9–14.

2. Lindner A, Charra B, Sherrard DJ, Scribner BH. Accelerated atherosclerosis in prolonged maintenance hemodialysis. N Engl J Med. 1974. 290:697–701.

3. Blacher J, Pannier B, Guerin AP, Marchais SJ, Safar ME, London GM. Carotid arterial stiffness as a predictor of cardiovascular and all-cause mortality in end-stage renal disease. Hypertension. 1998. 32:570–574.

4. Ibels LS, Alfrey AC, Huffer WE, Craswell PW, Anderson JT, Weil R 3rd. Arterial calcification and pathology in uremic patients undergoing dialysis. Am J Med. 1979. 66:790–796.

5. Ansari A, Kaupke CJ, Vaziri ND, Miller R, Barbari A. Cardiac pathology in patients with end-stage renal disease maintained on hemodialysis. Int J Artif Organs. 1993. 16:31–36.

6. Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM. Impact of aortic stiffness on survival in end-stage renal disease. Circulation. 1999. 99:2434–2439.

7. Shoji T, Emoto M, Shinohara K, Kakiya R, Tsujimoto Y, Kishimoto H, Ishimura E, Tabata T, Nishizawa Y. Diabetes mellitus, aortic stiffness, and cardiovascular mortality in end-stage renal disease. J Am Soc Nephrol. 2001. 12:2117–2124.

8. Nitta K, Akiba T, Uchida K, Otsubo S, Otsubo Y, Takei T, Ogawa T, Yumura W, Kabaya T, Nihei H. Left ventricular hypertrophy is associated with arterial stiffness and vascular calcification in hemodialysis patients. Hypertens Res. 2004. 27:47–52.

9. Zoungas S, Cameron JD, Kerr PG, Wolfe R, Muske C, McNeil JJ, McGrath BP. Association of carotid intima-medial thickness and indices of arterial stiffness with cardiovascular disease outcomes in CKD. Am J Kidney Dis. 2007. 50:622–630.

10. Frimodt-Møller M, Nielsen AH, Kamper AL, Strandgaard S. Reproducibility of pulse-wave analysis and pulse-wave velocity determination in chronic kidney disease. Nephrol Dial Transplant. 2008. 23:594–600.

11. Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, Gutgesell H, Reichek N, Sahn D, Schnittger I. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr. 1989. 2:358–367.

12. Chambless LE, Folsom AR, Clegg LX, Sharrett AR, Shahar E, Nieto FJ, Rosamond WD, Evans G. Carotid wall thickness is predictive of incident clinical stroke: the Atherosclerosis Risk in Communities (ARIC) study. Am J Epidemiol. 2000. 151:478–487.

13. Covic A, Mardare N, Gusbeth-Tatomir P, Prisada O, Sascau R, Goldsmith DJ. Arterial wave reflections and mortality in haemodialysis patients--only relevant in elderly, cardiovascularly compromised? Nephrol Dial Transplant. 2006. 21:2859–2866.

14. Safar ME, Frohlich ED. The arterial system in hypertension: a prospective view. Hypertension. 1995. 26:10–14.

15. Wada T, Kodaira K, Fujishiro K, Maie K, Tsukiyama E, Fukumoto T, Uchida T, Yamazaki S. Correlation of ultrasound-measured common carotid artery stiffness with pathological findings. Arterioscler Thromb. 1994. 14:479–482.

16. London GM, Guerin AP, Marchais SJ, Pannier B, Safar ME, Day M, Metivier F. Cardiac and arterial interactions in end-stage renal disease. Kidney Int. 1996. 50:600–608.

17. Park HY, Lee SY, Cho SW, Kwon SU, Namgung J, Hyung J, Lee WR. Correlations between the left ventricular diastolic function and aortic stiffness in healthy aged subjects. Korean Circ J. 2006. 36:393–399.

18. London GM, Marchais SJ, Safar ME, Genest AF, Guerin AP, Metivier F, Chedid K, London AM. Aortic and large artery compliance in end-stage renal failure. Kidney Int. 1990. 37:137–142.

19. Marchais SJ, Guerin AP, Pannier BM, Levy BI, Safar ME, London GM. Wave reflections and cardiac hypertrophy in chronic uremia: influence of body size. Hypertension. 1993. 22:876–883.

20. Guerin AP, Blacher J, Pannier B, Marchais SJ, Safar ME, London GM. Impact of aortic stiffness attenuation on survival of patients in end-stage renal disease. Circulation. 2001. 103:987–992.

21. Zureik M, Touboul PJ, Bonithon-Kopp C, Courbon D, Berr C, Leroux C, Ducimetière P. Cross-sectional and 4-year longitudinal associations between brachial pulse pressure and common carotid intima-media thickness in a general population. The EVA study. Stroke. 1999. 30:550–555.

22. Karalliedde J, Smith A, DeAngelis L, Mirenda V, Kandra A, Botha J, Ferber P, Viberti G. Valsartan improves arterial stiffness in type 2 diabetes independently of blood pressure lowering. Hypertension. 2008. 51:1617–1623.

23. Shinohara K, Shoji T, Kimoto E, Yokoyama H, Fujiwara S, Hatsuda S, Maeno T, Shoji T, Fukumoto S, Emoto M, Koyama H, Nishizawa Y. Effects of atorvastatin on regional arterial stiffness in patients with type 2 diabetes mellitus. J Atheroscler Thromb. 2005. 12:205–210.

24. Wilkinson IB, Fuchs SA, Jansen IM, Spratt JC, Murray GD, Cockcroft JR, Webb DJ. Reproducibility of pulse wave velocity and augmentation index measured by pulse wave analysis. J Hypertens. 1998. 16:2079–2084.

25. O'Rourke MF, Kelly RP. Wave reflection in the systemic circulation and its implications in ventricular function. J Hypertens. 1993. 11:327–337.

26. Safar ME, London GM. Therapeutic studies and arterial stiffness in hypertension: recommendations of the European Society of Hypertension. The Clinical Committee of Arterial Structure and Function. Working Group on Vascular Structure and Function of the European Society of Hypertension. J Hypertens. 2000. 18:1527–1535.

27. McEniery CM, Yasmin , Hall IR, Qasem A, Wilkinson IB, Cockcroft JR. ACCT Investigators. Normal vascular aging: differential effects on wave reflection and aortic pulse wave velocity: the Anglo-Cardiff Collaborative Trial (ACCT). J Am Coll Cardiol. 2005. 46:1753–1760.

28. Woodman RJ, Kingwell BA, Beilin LJ, Hamilton SE, Dart AM, Watts GF. Assessment of central and peripheral arterial stiffness: studies indicating the need to use a combination of techniques. Am J Hypertens. 2005. 18:249–260.

29. Williams B, Lacy PS, Thom SM, Cruickshank K, Stanton A, Collier D, Hughes AD, Thurston H, O'Rourke M. CAFE Investigators. Anglo-Scandinavian Cardiac Outcomes Trial Investigators. CAFE Steering Committee and Writing Committee. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation. 2006. 113:1213–1225.

30. Wimmer NJ, Townsend RR, Joffe MM, Lash JP, Go AS. Chronic Renal Insufficiency Cohort Study Investigators. Correlation between pulse wave velocity and other measures of arterial stiffness in chronic kidney disease. Clin Nephrol. 2007. 68:133–143.

31. McEniery CM, Wallace S, Mackenzie IS, McDonnell B, Yasmin , Newby DE, Cockcroft JR, Wilkinson IB. Endothelial function is associated with pulse pressure, pulse wave velocity, and augmentation index in healthy humans. Hypertension. 2006. 48:602–608.