Premature Aortic Stiffness in Relation to Cerebral Small Vessel Disease, Cognitive Decline, Major Cardiovascular Events and Mortality in Dialysis

Introduction: There is a great burden of cerebral small-vessel disease (CSVD) in dialysis population. Arterial stiffness, normally assessed by pulse wave velocity (PWV), is an important risk factor for CSVD. We aimed to investigate the effect of PWV on CSVD and related consequences, including cognitive function, cardiovascular disease (CVD), and mortality in dialysis. Methods: In a prospective cohort of maintenance dialysis adults, 3 features of CSVD including cerebral microbleed (CMB), lacunae, and white matter hyperintensity (WMH) were measured. PWV was assessed by sequential recording of electrocardiogram-gated carotid and femoral artery pressure waves. The effect of PWV on CSVD and cognitive impairment were investigated by multivariate regression analysis. Cox proportional hazards model was used to assess the risk of CVD and mortality up to 10 years follow-up. Results: In the 178 study subjects, the frequency of CMB, lacunae, and WMH was 32.6%, 25.3%, and 34.8%. PWV was related to the risk of lacunae in subcortical white matter (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.02 to 1.20) and WMH (OR, 1.11; 95% CI, 1.02 to 1.20) in crude analyses. Unadjusted associations between PWV and cognitive impairment, which were reflected in loss of global function, verbal memory and executive function, were also detected. At follow-up, PWV was associated with CVD (hazard ratio [HR], 1.13; 95% CI, 1.08 to 1.18) and all-cause mortality (HR, 1.11; 95% CI, 1.06 to 1.16) after confounder adjustment. Restricted cubic splines depicted a linear relationship between PWV and the outcome events. Conclusion: PWV was associated with all-cause mortality and CVD, independent of age and sex. PWV was associated with CVSD and cognitive decline in unadjusted analyses. PWV is a widely available measurement and could be an early biomarker and provide predictive value in this population.