Pulse wave velocity is a marker of arterial stiffness. Unequal arterial stiffness has been associated with increased risk of cardiovascular events. This study calculated bilateral brachial-ankle pulse wave velocity (baPWV) differences and investigated the associations of unequal bilateral baPWV with overall and cardiovascular mortality in patients receiving hemodialysis (HD).
Materials and Methods
A total of 205 patients receiving HD were enrolled in this study. The mean follow-up period was 4.4 ± 1.5 years. The baPWV was measured using an ankle-brachial index-form device, and bilateral baPWV difference was calculated and defined as ΔbaPWV.
The median value of ΔbaPWV was 88 cm/second. ankle-brachial index < 0.95 and high baPWV were independently associated with a ΔbaPWV ≥ 88 cm/s. Furthermore, patients with a ΔbaPWV ≥ 88 cm/s demonstrated poorer overall (log-rank P = 0.035) and cardiovascular (log-rank P = 0.036) survival than did those with a ΔbaPWV < 88 cm/s. After multivariate analysis, this difference was independently associated with overall (hazard ratio = 1.006; 95% CI: 1.001-1.011; P = 0.024) and cardiovascular (hazard ratio = 1.006; 95% CI: 1.000-1.013; P = 0.049) mortality.
ΔbaPWV was associated with an increased risk of cardiovascular and overall mortality in patients receiving HD. Earlier evaluation of ΔbaPWV may facilitate the identification of patients receiving HD who have an increased risk of cardiovascular and overall mortality.
Key Indexing Terms
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- Aortic pulse wave velocity is a strong predictor of all—cause and cardiovascular mortality in chronic dialysis patients.Ren Fail. 2014; 36: 176-186
- Aortic pulse wave velocity index and mortality in end-stage renal disease.Kidney Int. 2003; 63: 1852-1860
- Validity, reproducibility, and clinical significance of noninvasive brachial-ankle pulse wave velocity measurement.Hypertens Res. 2002; 25: 359-364
- Brachial-ankle pulse wave velocity and the cardio-ankle vascular index as a predictor of cardiovascular outcomes in patients on regular hemodialysis.Ther Apher Dial. 2012; 16: 232-241
- Regional arterial stiffness associated with ischemic heart disease in type 2 diabetes mellitus.J Atheroscler Thromb. 2006; 13: 114-121
- Large artery stiffness predicts ischemic threshold in patients with coronary artery disease.J Am Coll Cardiol. 2002; 40: 773-779
- Stiffness of capacitive and conduit arteries: prognostic significance for end-stage renal disease patients.Hypertension. 2005; 45: 592-596
- Influences of age and gender on results of noninvasive brachial-ankle pulse wave velocity measurement—a survey of 12517 subjects.Atherosclerosis. 2003; 166: 303-309
- Pulse wave velocity in lower-limb arteries among diabetic patients with peripheral arterial disease.J Atheroscler Thromb. 2003; 10: 253-258
- Determinants of peripheral arterial stiffness in patients with chronic kidney disease in southern taiwan.Kaohsiung J Med Sci. 2009; 25: 366-373
- Comparison of ankle-brachial index and brachial-ankle pulse wave velocity between patients with chronic kidney disease and hemodialysis.Am J Nephrol. 2008; 29: 374-380
- Ankle brachial index as a predictor for mortality in patients with chronic kidney disease and undergoing haemodialysis.Nephrology (Carlton). 2010; 15: 294-299
- Significant correlation between ankle-brachial index and vascular access failure in hemodialysis patients.Clin J Am Soc Nephrol. 2009; 4: 128-134
- Sensitivity and specificity of ankle-brachial index for detecting angiographic stenosis of peripheral arteries.Circ J. 2008; 72: 605-610
- Simplified equations for monitoring Kt/V, PCRn, eKt/V, and ePCRn.Adv Ren Replace Ther. 1995; 2: 295-304
- Cardiac and arterial interactions in end-stage renal disease.Kidney Int. 1996; 50: 600-608
- Calcified plaque is common in the carotid and femoral arteries of dialysis patients without clinical vascular disease.Nephrol Dial Transplant. 1998; 13: 2004-2012
- Arterial wave reflections and survival in end-stage renal failure.Hypertension. 2001; 38: 434-438
- Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis.J Am Coll Cardiol. 2010; 55: 1318-1327
- 2007 Guidelines for the management of arterial hypertension: The task force for the management of arterial hypertension of the european society of hypertension (ESH) and of the european society of cardiology (ESC).J Hypertens. 2007; 25: 1105-1187
- Central versus peripheral arterial stiffness in association with coronary, cerebral and peripheral arterial disease.Atherosclerosis. 2010; 211: 480-485
- The association between regional arterial stiffness and diabetic retinopathy in type 2 diabetes.Atherosclerosis. 2012; 225: 237-241
- Association of bilateral brachial-ankle pulse wave velocity difference with peripheral vascular disease and left ventricular mass index.PloS One. 2014; 9: e88331
- Clinical usefulness of assessment of ankle-brachial index and carotid stenosis in type 2 diabetic population-three-year cohort follow-up of mortality.Angiology. 2013; 64: 64-68
- Impact of brachial-ankle pulse wave velocity and ankle-brachial blood pressure index on mortality in hemodialysis patients.Am J Kidney Dis. 2005; 46: 688-696
- Prognostic value of low and high ankle-brachial index in hospitalized medical patients.Eur J Intern Med. 2012; 23: 240-244
- Echocardiographic parameters are independently associated with increased cardiovascular events in patients with chronic kidney disease.Nephrol Dial Transplant. 2012; 27: 1064-1070
- Assessment of arterial distensibility by automatic pulse wave velocity measurement. Validation and clinical application studies.Hypertension. 1995; 26: 485-490
- Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease.Hypertension. 2001; 38: 938-942
- Impact of aortic stiffness on survival in end-stage renal disease.Circulation. 1999; 99: 2434-2439
- Comparison between carotid-femoral and brachial-ankle pulse wave velocity as measures of arterial stiffness.J Hypertens. 2009; 27: 2022-2027
- Noninvasive assessment of carotid-femoral pulse wave velocity: the influence of body side and body contours.J Hypertens. 2013; 31: 946-951
Accepted: October 22, 2016
Received: July 3, 2015
The authors have no financial or other conflicts of interest to disclose.
© 2016 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.