In hemodialysis patients, higher pulse-wave velocity (>9.85 m/s) was associated with increased all-cause mortality (HR 3.1; 95% CI 1.51-6.34; p=0.002).
Observational (n=173)
Do baseline pulse-wave velocity and cardiac biomarkers (NT-proBNP, Gal-3) predict long-term mortality and MACE in hemodialysis patients?
In hemodialysis patients, higher arterial stiffness (PWV >9.85 m/s) and elevated NT-proBNP are associated with increased long-term mortality, suggesting utility in cardiovascular risk stratification.
Hazard Ratio: 3.1 (95% CI 1.51–6.34)
p-value: p=0.002
Objective: Mortality in hemodialysis (HD) remains high and is not fully explained by traditional risk factors. Biomarkers reflecting myocardial stress and fibrosis, together with measures of vascular stiffness, may provide additional prognostic information in this population. Design and method: This is a long-term observational study evaluating 173 HD patients over a follow-up period of 13 years. Baseline PWV, NT-proBNP and Gal-3 were measured. Patients were classified into four groups based on median NT-proBNP and Gal-3 levels. Outcomes were: all-cause mortality, major adverse cardiovascular events (three-point MACE defined as non-fatal stroke, non-fatal acute myocardial infarction or cardiovascular death) and PWV association with mortality. Survival was assessed using Kaplan–Meier analysis and Cox proportional hazards models adjusted for age, sex, diabetes, hypertension, peripheral artery disease and dialysis vintage. MACE was analyzed using logistic regression. PWV was evaluated as a continuous variable and dichotomized at the cohort median (9.85 m/s). Interaction analyses explored the combined effects of PWV and biomarker-defined groups. Results: Over long-term follow-up, all-cause mortality occurred in 76.9% patients and differed significantly across the four biomarker-defined groups (p=0.014), with progressively shorter survival in patients with higher NT-proBNP levels, irrespective of Gal-3 levels. For MACE analysis, 34 MACE events occured (26.8%), of which: 79.4% cardiovascular deaths, 14.7% non-fatal myocardial infarctions, and 5.9% non-fatal strokes. After adjusting for demographic, vascular and dialysis-related factors, peripheral artery disease (PAD) emerged as the leading independent predictor of MACE, with patients diagnosed with PAD showing a 5.5-fold higher risk compared to those without PAD. Diabetes was more frequent in patients with adverse outcomes but this relationship did not reach statistical significance. Although higher NT-pro-BNP was significantly associated with mortality, no individual biomarker-defined group showed an independent association with adverse outcomes. No independent association to MACE was found for PWV, however higher PWV (>9.85 m/s) was associated with increased all-cause mortality (HR 3.1, 95% CI 1.51–6.34, p=0.002).Conclusions: In hemodialysis patients, higher arterial stiffness assessed by PWV and elevated NT-proBNP levels are associated with increased long-term mortality. The combined assessment of vascular stiffness and cardiac biomarkers may help refine cardiovascular risk stratification beyond traditional factors.
Stefan et al. (Fri,) conducted a observational in Hemodialysis (n=173). Higher pulse-wave velocity (>9.85 m/s) vs. Lower pulse-wave velocity (≤9.85 m/s) was evaluated on All-cause mortality (HR 3.1, 95% CI 1.51-6.34, p=0.002). In hemodialysis patients, higher pulse-wave velocity (>9.85 m/s) was associated with increased all-cause mortality (HR 3.1; 95% CI 1.51-6.34; p=0.002).