Key result
Higher baseline XSPI linked to ~40% higher all-cause mortality per SD in hemodialysis patients.
Why the study?
Does the excess pressure integral (XSPI) predict long-term all-cause and cardiovascular mortality in end-stage renal disease patients on hemodialysis?
Cohort (n=267)
Yes
Does the excess pressure integral (XSPI) predict long-term all-cause and cardiovascular mortality in end-stage renal disease patients on hemodialysis?
The excess pressure integral (XSPI) is a significant independent predictor of long-term all-cause and cardiovascular mortality in end-stage renal disease patients on hemodialysis, offering incremental prognostic value over conventional factors.
Answers are grounded in this paper and cite their sources.
XSPI was associated with higher mortality in hemodialysis patients; leaves open its added value for risk stratification in prospective studies.
Background The excess pressure integral ( XSPI ), derived from analysis of the arterial pressure curve, may be a significant predictor of cardiovascular events in high‐risk patients. We comprehensively investigated the prognostic value of XSPI for predicting long‐term mortality in end‐stage renal disease patients undergoing regular hemodialysis. Methods and Results A total of 267 uremic patients (50.2% female; mean age 54.2±14.9 years) receiving regular hemodialysis for more than 6 months were enrolled. Cardiovascular parameters were obtained by echocardiography and applanation tonometry. Calibrated carotid arterial pressure waveforms were analyzed according to the wave‐transmission and reservoir‐wave theories. Multivariable Cox proportional hazard models were constructed to account for age, sex, diabetes mellitus, albumin, body mass index, and hemodialysis treatment adequacy. Incremental utility of the parameters to risk stratification was assessed by net reclassification improvement. During a median follow‐up of 15.3 years, 124 deaths (46.4%) incurred. Baseline XSPI was significantly predictive of all‐cause (hazard ratio per 1 SD 1.4, 95% confidence interval 1.15‐1.70, P =0.0006) and cardiovascular mortalities (1.47, 1.18‐1.84, P =0.0006) after accounting for the covariates. The addition of XSPI to the base prognostic model significantly improved prediction of both all‐cause mortality (net reclassification improvement=0.1549, P =0.0012) and cardiovascular mortality (net reclassification improvement=0.1535, P =0.0033). XSPI was superior to carotid‐pulse wave velocity, forward and backward wave amplitudes, and left ventricular ejection fraction in consideration of overall independent and incremental prognostics values. Conclusions In end‐stage renal disease patients undergoing regular hemodialysis, XSPI was significantly predictive of long‐term mortality and demonstrated an incremental value to conventional prognostic factors.
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Huang et al. (2017) conducted a cohort in End-stage renal disease (ESRD) undergoing hemodialysis (n=267). Excess pressure integral (XSPI) vs. Lower XSPI (per 1 SD increase) was evaluated on All-cause mortality (HR 1.4, 95% CI 1.15-1.70, p=0.0006). Higher baseline excess pressure integral (XSPI) significantly predicted long-term all-cause mortality (HR 1.4 per 1 SD increase) in end-stage renal disease patients undergoing hemodialysis.
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