Impact of Aortic Stiffness on Survival in End-Stage Renal Disease
Open accessAbstract
Background —Damage to large arteries is a major factor in the high cardiovascular morbidity and mortality of patients with end-stage renal disease (ESRD). Increased arterial stiffness and intima-media thickness, together with increased pulse pressure, are the principal arterial alterations. Whether increased aortic pulse-wave velocity (PWV), a classic marker of increased arterial stiffness, may predict all-cause and/or cardiovascular mortality has never been investigated. Methods and Results —A cohort of 241 patients with ESRD undergoing hemodialysis was studied between April 1987 and April 1998. The mean duration of follow-up was 72±41 months (mean±SD). Mean age at entry was 51.5±16.3 years. Seventy-three deaths occurred, including 48 cardiovascular and 25 noncardiovascular fatal events. At entry, together with standard clinical and biochemical analyses, patients underwent echocardiography and aortic PWV measured by Doppler ultrasonography. On the basis of Cox analyses, 2 factors emerged as predictors of all-cause and cardiovascular mortality: age and aortic PWV. Hemoglobin and low diastolic pressure interfered to a smaller extent. After adjustment for all the confounding factors, an OR for PWV >12.0 versus <9.4 m/s was 5.4 (95% CI, 2.4 to 11.9) for all-cause mortality and 5.9 (95% CI, 2.3 to 15.5) for cardiovascular mortality. For each PWV increase of 1 m/s in our study population, all-cause mortality–adjusted OR was 1.39 (95% CI, 1.19 to 1.62). Conclusions —These results provide the first direct evidence that in patients with ESRD, increased aortic stiffness determined by measurement of aortic PWV is a strong independent predictor of all-cause and mainly cardiovascular mortality.
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Aortic PWV is an independent risk factor for total and cardiovascular mortality.
“Epidemiological data now show that PWV is an independent risk factor for total and cardiovascular mortality. 21,23”
From Acute Effect of Caffeine on Arterial Stiffness and Aortic Pressure Waveform (2001) · cites this paper as [21]
The Outcome and Prognostic Impact of Aortic PWV section reports that, after adjustment, aortic PWV predicted both all-cause and cardiovascular mortality. The study followed patients with end-stage renal disease undergoing hemodialysis, so it does not establish the unqualified claim for other populations; page numbers are not supplied in the passages. (LLM, conf=0.86)
Experimental — accuracy not yet measuredAortic PWV is an independent risk factor for cardiovascular and all-cause mortality in hypertension and in renal disease.
“there is increasing evidence that aortic PWV is an independent risk factor for cardiovascular and all-cause mortality in hypertension 19,20 and in renal disease. 21”
From Acute Effect of Caffeine on Arterial Stiffness and Aortic Pressure Waveform (2001) · cites this paper as [21]
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Cites
Levy, D., Garrison, R. J., Savage, D. D., Kannel, W. B., & Castelli, W. P. (1990) · New England Journal of Medicine · doi:10.1056/nejm199005313222203 · Cited by 5,699 · see citing works
Besarab, A., Bolton, W. K., Browne, J. K., Egrie, J. C., Nissenson, A. R., Okamoto, D. M., Schwab, S. J., & Goodkin, D. A. (1998) · New England Journal of Medicine · doi:10.1056/nejm199808273390903 · Cited by 1,930 · see citing works
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Research works printed but not linked: 29
- Lindner A, Charra B, Sherrard DJ, Scribner BH. Accelerated atheroscle- rosis in prolonged maintenance hemodialysis. N Engl J Med. 1974;290: 697-701.
- Rostand SG, Gretes JC, Kirk KA, Rutsky EA, Andreoli TE. Ischemic heart disease in patients with uremia undergoing maintenance hemodi- alysis. Kidney Int. 1979;16:600 -611.
- London GM, Gue ´rin 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.
- Nichols WW, O'Rourke MF. Vascular impedance. In: McDonald's Blood Flow in Arteries: Theoretical, Experimental and Clinical Principles. 4th ed. London, UK: Edward Arnold; 1998:54 -97, 243-283, 347-395.
- Darne ´B, Girerd X, Safar M, Cambien F, Guize L. Pulsatile versus steady component of blood pressure. a cross-sectional and prospective analysis on cardiovascular mortality. Hypertension. 1989;13:392-400.
- Silberberg JS, Barre PE, Prichard SS, Sniderman AD. Impact of left ventricular hypertrophy on survival in end-stage renal disease. Kidney Int. 1989;36:286 -290.
- Parfrey PS, Foley RN, Harnett JD, Kent GM, Murray D, Barre PE. Outcome and risk factors of ischemic heart disease in chronic uremia. Kidney Int. 1996;49:1428 -1434.
- Iseki K, Miyasato F, Tokuyama K, Nishime K, Uehara H, Shiohira Y, Sunagawa H, Yoshihara K, Yoshi S, Toma S, Kowatari T, Wake T, Oura T, Fukiyama K. Low diastolic blood pressure, hypoalbuminemia, and risk of death in cohort of chronic hemodialysis patients. Kidney Int. 1997;51: 1212-1217.
- Avolio AP, Chen S, Wang R, Zhang C, Li M, O'Rourke MF. Effects of aging on changing arterial compliance and left ventricular load in a northern Chinese urban community. Circulation. 1983;68:50 -58.
- Asmar R, Benetos A, Topouchian J, Laurent P, Pannier B, Brisac A-M, Target R, Levy BI. Assessment of arterial distensibility by automatic pulse wave velocity measurement: validation and clinical application study. Hypertension. 1995;26:485-490.
- Sahn DJ, De Maria A, Kisslo J, Weyman A. Recommendations regarding quantitation in M-mode echocardiographic measurements. Circulation. 1978;58:1072-1083.
- Devereux RB, Reichek N. Echocardiographic determination of left ven- tricular mass in man: anatomic validation of the method. Circulation. 1977;55:613-618.
- London GM, Marchais SJ, Guerin AP, Metivier F, Safar ME, Fabiani F, Froment L. Salt and water retention and calcium blockade in uremia. Circulation. 1990;82:105-113.
- Safar ME, Frohlich ED. The arterial system in hypertension: a pro- spective view. Hypertension. 1995;26:10 -14.
- Lehmann ED, Gosling RG, So ¨nksen PH. Arterial wall compliance in diabetes. Diabet Med. 1992;9:114 -119.
- 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.
- Hirai T, Sasayama S, Kawasaki T, Yagi S. Stiffness of systemic arteries in patients with myocardial infarction. Circulation. 1989;80:78 -86.
- Blacher J, Pannier B, Guerin A, Marchais S, Safar M, London G. Impact of carotid stiffness on cardiovascular and all-cause mortality in end-stage renal failure. Hypertension. 1998;32:570 -574.
- Avolio A. Genetic and environmental factors in the function and structure of the arterial wall. Hypertension. 1995;26:34 -37.
- Boutouyrie P, Laurent S, Girerd X, Benetos A, Lacolley P, Abergel E, Safar M. Common carotid artery stiffness and patterns of left ventricular hypertrophy in hypertensive patients. Hypertension. 1995;25:651-659.
- Witteman JC, Grobbee DE, Valkenburg HA, van Hemert AM, Stijnen T, Burger H, Hofman A. J-shaped relation between change in diastolic pressure and progression of aortic atherosclerosis. Lancet. 1994;343: 504 -507.
- Charra B, Calemard E, Ruffet M, Chazot C, Terrat JC, Vanel T, Laurent G. Survival as an index of adequacy of dialysis. Kidney Int. 1992;41: 1286 -1291.
- Salem MM, Bower J. Hypertension in the hemodialysis population: any relation to one-year survival? Am J Kidney Dis. 1996;28:737-740.
- Mallick MP, Brunner EP, Jones E, Selwood NH. Analysis of causes of death and of the direction of management to improve survival: data from European renal association registry (ERA-EDTA). In: Death on Hemo- dialysis: Preventable or Inevitable? Friedman EA, ed. Dordrecht, Neth- erlands: Kluwer Academic Publisher; 1994:25-33.
- Gagnon DR, Zhang TJ, Brand FN, Kannel WB. Hematocrit and the risk of cardiovascular disease: the Framingham study: a 34-year follow-up. Am Heart J. 1994;127:674 -682.
- Foley RN, Parfrey PS, Harnett JD, Kent GM, Murray DC, Barre PE. The impact of anemia on cardiomyopathy, morbidity, and mortality in end-stage renal disease. Am J Kidney Dis. 1996;28:53-61.
- Iseki K, Nishime K, Uehara H, Tokuyama K, Toma S, Yoshihara K, Kowatari T, Terukina S, Osawa A, Fukiyama K. Increased risk of car- diovascular disease with erythropoietin in chronic dialysis patients. Nephron. 1996;72:30 -36.
- Zmirou D, Benhamou P-Y, Cordonnier D, Borgel F, Balducci F, Papoz L, Hamimi S. Diabetes mellitus prevalence among dialysed patients in France (UREMIDIAB Study). Nephrol Dial Transplant. 1992;7: 1092-1097.
- Jungers P, Skhiri H, Giatras I, Touam M, Nguyen AT, Massy Z, Zingraff J, Man NK. Incidence and causes of death in hemodialysis patients: a prospective study in the Ile de France Area. J Am Soc Nephrol. 1998; 8:196. Abstract.
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“…studies have shown that PWV is a predictor of cardiovascular outcome in the general population (Hansen et al 2006) and in patients with hypertension (Asmar et al 2001; Laurent et al 2001; Bout-ouyrie et al 2002), diabetes (Cruickshank et al 2002), and hemodialysis (Blacher et al 1999) patients.”
- Authors
- Blacher, J., Guerin, A. P., Pannier, B., Marchais, S. J., Safar, M. E., & London, G. M.
- Affiliations
- Hôpital Broussais (FR)
- From the Service de Médecine, Hôpital Broussais, Paris (J.B., M.E.S.), and the Hôpital F.H. Manhès, Fleury-Mérogis (A.P.G., B.P., S.J.M., G.M.L.), France.
- Venue
- Circulation
- Published
- 1999-05-11
- Volume
- 99
- Issue
- 18
- Pages
- 2434-2439
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2161924597
- Cited by
- 2,138
- References
- 2
- Citations by year
- 2026: 9 · 2025: 26 · 2024: 35 · 2023: 41 · 2022: 45 · 2021: 56 · 2020: 52 · 2019: 58 · 2018: 62 · 2017: 76 · 2016: 87 · 2015: 101 · 2014: 110 · 2013: 108 · 2012: 121
- FWCI
- 38.18
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Renal and Vascular Pathologies
- Keywords
- aortic stiffness, pulse wave velocity, end-stage renal disease, hemodialysis, cardiovascular mortality, all-cause mortality, mortality prediction, arterial stiffness, Doppler ultrasound
- MeSH terms
- Adult, Aged, Aorta, Aortic Diseases, Arteriosclerosis, Cardiovascular Diseases, Cause of Death, Diabetes Mellitus, Type 1, Elasticity, Female, Renal Dialysis, Humans, Hyperlipidemias, Hypertension, Hypertrophy, Kidney Failure, Chronic, Male, Middle Aged, Prognosis, Prospective Studies, Risk Factors, Smoking, Cohort Studies, Comorbidity, Life Tables, Proportional Hazards Models, Survival Analysis, Treatment Outcome, Hypertrophy, Left Ventricular, Ultrasonography, Doppler
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