Abstract
Aortic stiffness, measured by carotid-femoral pulse wave velocity (PWV), is a predictor of cardiovascular (CV) mortality in patients with end-stage renal disease (ESRD). Aortic stiffness increases aortic systolic and pulse pressures (cSBP, cPP) and augmentation index adjusted for a heart rate of 75 beats per minute (AIx@75). In this study, we examined if the integration of multiple components of central blood pressure and aortic stiffness (ICPS) into risk score categories could improve CV mortality prediction in ESRD. In a prospective cohort of 311 patients with ESRD on dialysis who underwent vascular assessment at baseline, 118 CV deaths occurred after a median follow-up of 3.1 years. The relationship between hemodynamic parameters and CV mortality was analyzed through Kaplan–Meier and Cox survival analysis. ICPS risk score from 0 to 5 points were calculated from points given to tertiles, and were regrouped into three risk categories (Average, High, Very-High). A strong association was found between the ICPS risk categories and CV mortality (High risk HR = 2.20, 95% CI: 1.05–4.62, P = 0.036); Very-High risk (HR = 4.44, 95% CI: 2.21–8.92, P < 0.001) as compared to the Average risk group. The Very-High risk category remained associated with CV mortality (HR = 3.55, 95% CI: 1.37–9.21, P = 0.009) after adjustment for traditional CV risk factors as compared to the Average risk group. While higher C-statistics value of ICPS categories (C: 0.627, 95% CI: 0.578–0.676, P = 0.001) was not statistically superior to PWV, cPP or AIx@75, the use of ICPS categories resulted in a continuous net reclassification index of 0.56 (95% CI: 0.07–0.99). In conclusion, integration of multiple components of central blood pressure and aortic stiffness may potentially be useful for better prediction of CV mortality in this cohort.
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Data availability
The datasets analyzed during the current study are available from the corresponding author upon reasonable request.
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Acknowledgements
We are grateful to the dialysis personnel for their generous contribution and collaboration.
Funding
This project was supported by the Canadian Institute of Health Research (CIHR), New Emerging Team Grant (NET-54008), the Heart and Stroke Foundation of Canada, the Kidney Foundation of Canada, and the Canadian Diabetes Association. CF is supported by the Research chair in nephrology from the Fondation de l’Université Laval. NC holds a scholarship from the Société québecoise d’hypertension artérielle.
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NC was involved in data analysis and in writing. CF was involved in data gathering and data analysis. LCD was involved in data analysis. JN was involved in study conceptualization and reviewing. MA was involved in study conceptualization, methodology, data analysis and writing.
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The study had been approved by the Comité d’éthique de la recherche du CHU de Québec and was conducted in accordance with the Declaration of Helsinki. Institutional guidelines were followed, and each patient included provided informed written consent.
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Côté, N., Fortier, C., Desbiens, LC. et al. Individual versus integration of multiple components of central blood pressure and aortic stiffness in predicting cardiovascular mortality in end-stage renal diseases. J Hum Hypertens 38, 430–436 (2024). https://doi.org/10.1038/s41371-023-00888-w
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DOI: https://doi.org/10.1038/s41371-023-00888-w