What is the clinical evidence from this study?

Study design: Cohort. Population: Hemodialysis (n=135). Intervention: Brachial-ankle pulse wave velocity (baPWV) vs. Lower tertiles of baPWV (<16.6 m/s). Primary outcome: Cardiovascular death (HR 16.9, 95% CI 1.1-251.8, p=<0.05).

What does this research mean for the field?

Brachial-ankle pulse wave velocity (baPWV) is superior to the cardio-ankle vascular index (CAVI) as a predictor of cardiovascular outcomes in hemodialysis patients, with high baPWV significantly predicting cardiovascular death. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

March 21, 2012

Brachial‐Ankle Pulse Wave Velocity and the Cardio‐Ankle Vascular Index as a Predictor of Cardiovascular Outcomes in Patients on Regular Hemodialysis

Q: What are the key findings of this study?

The highest tertile of brachial-ankle pulse wave velocity (≥16.6 m/s) was a significant predictor of cardiovascular death in hemodialysis patients (HR 16.9; 95% CI 1.1-251.8; P<0.05).

Q: What does this research mean for the field?

Brachial-ankle pulse wave velocity (baPWV) is superior to the cardio-ankle vascular index (CAVI) as a predictor of cardiovascular outcomes in hemodialysis patients, with high baPWV significantly predicting cardiovascular death. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

The highest tertile of brachial-ankle pulse wave velocity (≥16.6 m/s) was a significant predictor of cardiovascular death in hemodialysis patients (HR 16.9; 95% CI 1.1-251.8; P<0.05).

Study Design

Type

Cohort (n=135)

Structured PICO

Does brachial-ankle pulse wave velocity or cardio-ankle vascular index better predict cardiovascular outcomes in patients on regular hemodialysis?

Population

135 hemodialysis patients aged ≤76 years with normal ankle-brachial pressure index, followed for a mean of 63 months.

Exposure

Measurement of brachial-ankle pulse wave velocity (baPWV) and cardio-ankle vascular index (CAVI) to evaluate arterial stiffness

Comparator

Comparison between highest tertile of baPWV (≥16.6 m/s) and lower tertiles, and evaluation of CAVI

Outcome

Cardiovascular death and fatal/non-fatal cardiovascular events at 63 ± 4 months follow-uphard clinical

In patients on regular hemodialysis, brachial-ankle pulse wave velocity is superior to the cardio-ankle vascular index for predicting cardiovascular death.

Main Result

Hazard Ratio: 16.9 (95% CI 1.1–251.8)

p-value: p=<0.05

Abstract

Brachial-ankle pulse wave velocity (baPWV) and the cardio-ankle vascular index (CAVI) are both used to evaluate arterial stiffness. The aim of the present study is to determine whether baPWV or CAVI is superior as a marker of arterial stiffness in hemodialysis (HD) patients. Of 194 patients, 59 patients had been excluded from the study due to advanced age over 76 years old (n = 29), or abnormal ankle-brachial pressure index (ABI) (<0.90 or ≥1.30) (n = 30). We then followed the 135 patients (age: 60 ± 11 years, time on HD: 110 ± 93 months) for the 63 ± 4 (55-70) months. Thirty-two (23.7%) patients had expired, 22 of them of cardiovascular (CV) causes. There were 37 fatal and non-fatal CV events. Kaplan-Meier analysis revealed that the patients with the highest tertile of baPWV (≥16.6 m/s) had a significantly lower survival rate (P < 0.01) when compared with the second (13.4 ≤ baPWV < 16.6 m/s) and the lowest tertiles (<13.4 m/s). Cox hazards analysis after adjustment for comorbid risk factors revealed that the top tertile of baPWV was a determinant of CV death (hazards ratio HR: 16.9 1.1-251.8, P < 0.05) In contrast, CAVI did not associate with CV mortality or events. These findings suggest that baPWV is superior to CAVI as a predictor of CV outcomes in patients on regular HD.

Mark Helpful

Bookmark

Relay