From the Service de Médecine Interne, Hôpital Broussais,
Paris (J.B., M.E.S.), and Service d'Hémodialyse, Hôpital
F.H. Manhès, Fleury-Mérogis (B.P., A.P.G., S.J.M., G.M.L.),
France.
Correspondence to Dr G.M. London, Hôpital F.H. Manhès, 8, Grande Rue, Fleury-Mérogis, 91712 Ste Geneviève des Bois, Cedex, France.
Abstract
Abstract—Damage of large arteries is
a major contributory factor to the high pulse pressure observed in
patients with end-stage renal disease. Whether incremental modulus of
elasticity (Einc), a classic marker of arterial
stiffness, can predict cardiovascular mortality has
never been investigated. A cohort of 79 patients with end-stage renal
disease undergoing hemodialysis was studied between September 1995 and
January 1998. Mean age at entry was 58±15 years. The duration of
follow-up was 25±7 months, during which 10
cardiovascular and 8 noncardiovascular
fatal events occurred. At entry, carotid Einc was
calculated from measurements of diameter, thickness (echo-tracking
technique), and pulse pressure (tonometry). Based on Cox
analyses, 2 dominant factors emerged as predictors of all-cause
and cardiovascular mortality: increased
Einc and decreased diastolic blood pressure.
Lipid abnormalities and the presence of previous
cardiovascular events interfered to a smaller extent.
After adjustment for confounding variables, the odds ratio for
Einc
© 1998 American Heart Association, Inc.
Third Workshop on Structure and Function of Large Arteries: Part III
Carotid Arterial Stiffness as a Predictor of Cardiovascular and All-Cause Mortality in End-Stage Renal Disease
1 kPa-3 was 9.2 (95% confidence
interval, 2.4 to 35.0) for all-cause mortality. These results provide
the first direct evidence that in patients with end-stage renal disease
undergoing hemodialysis, arterial alterations, as
determined from carotid Einc, are strong independent
predictors of all-cause and cardiovascular mortality.
Key Words: kidney failure, chronic • hemodialysis • elasticity • mortality
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