Key result
Aortic pulse wave velocity assessment for cardiovascular risk stratification in ESKD patients provided only modest improvement in risk reclassification over standard clinical scores.
Why the study?
Among patients with ESKD, arterial stiffness is considered a powerful predictor of CV morbidity and mortality, but the relevance of aortic PWV as a prognostic biomarker for CV risk estimation remains unclear.
Does aortic pulse wave velocity assessment improve cardiovascular risk prognostication in patients with end-stage kidney disease?
Systematic Review
Does aortic pulse wave velocity assessment improve cardiovascular risk prognostication in patients with end-stage kidney disease?
Despite the pathophysiological relevance of arterial stiffness, aortic pulse wave velocity assessment has limited value for cardiovascular risk stratification in ESKD patients.
May refine CV risk estimation in ESKD; leaves open incremental value over standard models.
BACKGROUND: Among patients with end-stage kidney disease (ESKD), arterial stiffness is considered as a powerful predictor of cardiovascular (CV) morbidity and mortality. However, the relevance of aortic pulse wave velocity (PWV) as a prognostic biomarker for CV risk estimation is not yet fully clear. METHODS: We performed a systematic search of Medline/PubMed database from inception through August 21, 2019 to identify observational cohort studies conducted in ESKD patients and exploring the association of PWV with CV events and mortality. RESULTS: Whereas "historical" cohort studies showed aortic PWV to be associated with higher risk of CV and all-cause mortality, recent studies failed to reproduce the independent predictive value of aortic PWV in older ESKD patients. Studies using state-of-the-art prognostic tests showed that the addition of aortic PWV to standard clinical risk scores could only modestly improve CV risk reclassification. Studies associating improvement in PWV in response to blood pressure (BP)-lowering with improvement in survival cannot demonstrate direct cause-and-effect associations due to their observational design and absence of accurate methodology to assess the BP burden. CONCLUSION: Despite the strong pathophysiological relevance of arterial stiffness as a mediator of CV disease in ESKD, the assessment of aortic PWV for CV risk stratification in this population appears to be of limited value. Whether aortic PWV assessment is valuable in guiding CV risk factor management and whether such a therapeutic approach is translated into improvement in clinical outcomes, is an issue of clinical relevance that warrants investigation in properly-designed randomized trials.
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Georgianos et al. (2020) conducted a systematic review in End-stage kidney disease (ESKD). Aortic pulse wave velocity (PWV) assessment vs. Standard clinical risk scores was evaluated on Cardiovascular events and mortality. Aortic pulse wave velocity assessment for cardiovascular risk stratification in ESKD patients provided only modest improvement in risk reclassification over standard clinical scores.
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