Arterial Stiffness In Patients With End-Stage Renal Disease On Hemodialysis

Cardiovascular disease is the leading cause of morbidity and mortality in patients with end stage renal disease (ESRD). Although arterial stiffness is now recognized as an independent predictor of cardiovascular mortality in ESRD in Caucasian population, it is unknown if increased arterial stiffness is a risk factor for adverse cardiovascular outcomes in minorities. We therefore conducted a prospective study to study the measures of arterial stiffness (pulse wave velocity, PWV) and reflected wave (augmentation index, Aix) in a predominantly minority cohort of 77 patients with ESRD on hemodialysis and investigate the role of arterial stiffness in cardiovascular morbidity and all- cause mortality. PWV and AIx were determined from arterial waveforms recorded by SphygmoCor® device. 90% of measurements were taken immediately prior to dialysis sessions. Cardiovascular events were defined as either new onset myocardial infarction/congestive heart failure, arrhythmia related to ischemic cardiomyopathy/acute cerebrovascular event/peripheral vascular disease requiring medical or surgical intervention and this information was gathered from patient interviews and medical chart review. In this cohort, 72% were African Americans (AA), 24% Hispanics, and 4% were non-Hispanic whites. Mean age was 55 yrs; 61 % were male. Major causes of ESRD were diabetes (58 %) and hypertension was present in 91 %. Mean duration of dialysis was 41 mos. Mean PWV was 11 m/sec and mean AIx (corrected for heart rate 75 beats/min) was 24% in this cohort. All patients were followed for a mean of 36 months. A total of 4 fatal and 24 non-fatal cardiovascular events which included 15 cardiovascular events and 9 cerebrovascular events were recorded in 19 patients. PWV was elevated in this group (13.8 vs. 10.4m/s) in the group as compared to the group who did not have composite outcome. P< 0.047) On the basis of cox analysis, PWV emerged as significant predictor of composite outcome- cardiovascular event and/ or all- cause mortality.