Background: Cardiac disease, the major cause of death in ESRD is difficult to prognosticate. In 2011, our group for the first time showed that PWV variations determined mortality differences. We examined translational PWV changes vs ESRD mortality. Methods: PWV was measured by the foot-to-foot method and repeated after six months. Coronary artery calcification (CAC) was measured at 0, 12 and 24 months. Mortality outcomes were analyzed. Results: In 2007-2010, 466 ESRD patients, 229 M:237F, age 19-97 (65.6) years, were followed up for 28.9 months. 128 patients (74M:54F) died. Causes of death - acute myocardial infarction (AMI) in 47 (37%) (age 70, 26M:21F), sudden death (SD) in 29 (23%) (age 72, 19M:10F). Paired PWV available in 308 surviving patients and 106 patients who died. Baseline PWV was lower in surviving vs dead patients – 8.46 +/- 1.8 vs 9.43 +/- 3.75 (p=0.0005). Repeat PWV values were unchanged in 308 survivors (8.46 +/- 1.8 vs 8.53 +/- 1.85, p=0.5, NS). Repeat PWV increased in the 106 who died from 9.43 +/- 3.75 to 12.11 +/- 4.18 (p<0.0001). Of the 29 dead from SD, death occurred <12 hours after the last dialysis (ATLD) in 7, >24 hours ATLD in 20 and >48 hours ATLD in 17. Of the 47 dead from AMI, 6 died <12 hours ATLD, 35 died >24 hours ATLD and 23 died >48 hours ATLD. CAC values scatter did not allow for analysis but baseline CAC values were higher in the AMI/SD patients vs surviving patients. Conclusions: This is the first report to show a scalable direct relationship between translational PWV and mortality in ESRD. Penultimate PWV, more than baseline PWV predicted mortality. Higher ESRD deaths from AMI/SD occurred during the long interdialytic (weekend) period. We propose that PWV be monitored among all ESRD patients. Patients with high and/or increasing PWV values may require more intense cardiovascular analysis. Further research into new preventative/therapeutic options in this area of ESRD care is warranted.
Penultimate Pulse Wave Velocity, More than Baseline Pulse Wave Velocity, Predicted Mortality in Italian ESRD Cohort Study / Onuigbo, Macaulay A.; Bellasi, Antonio; Russo, Domenico; Di Iorio, Biagio Raffaele. - In: JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY. - ISSN 1046-6673. - (2012). (Intervento presentato al convegno ANNUAL MEETING AMERICAN SOCIETY OF NEPHROLOGY tenutosi a SAN DIEGO (USA) nel 30 OCTOBER- 4 NOVEMBER).
Penultimate Pulse Wave Velocity, More than Baseline Pulse Wave Velocity, Predicted Mortality in Italian ESRD Cohort Study
RUSSO, DOMENICO;
2012
Abstract
Background: Cardiac disease, the major cause of death in ESRD is difficult to prognosticate. In 2011, our group for the first time showed that PWV variations determined mortality differences. We examined translational PWV changes vs ESRD mortality. Methods: PWV was measured by the foot-to-foot method and repeated after six months. Coronary artery calcification (CAC) was measured at 0, 12 and 24 months. Mortality outcomes were analyzed. Results: In 2007-2010, 466 ESRD patients, 229 M:237F, age 19-97 (65.6) years, were followed up for 28.9 months. 128 patients (74M:54F) died. Causes of death - acute myocardial infarction (AMI) in 47 (37%) (age 70, 26M:21F), sudden death (SD) in 29 (23%) (age 72, 19M:10F). Paired PWV available in 308 surviving patients and 106 patients who died. Baseline PWV was lower in surviving vs dead patients – 8.46 +/- 1.8 vs 9.43 +/- 3.75 (p=0.0005). Repeat PWV values were unchanged in 308 survivors (8.46 +/- 1.8 vs 8.53 +/- 1.85, p=0.5, NS). Repeat PWV increased in the 106 who died from 9.43 +/- 3.75 to 12.11 +/- 4.18 (p<0.0001). Of the 29 dead from SD, death occurred <12 hours after the last dialysis (ATLD) in 7, >24 hours ATLD in 20 and >48 hours ATLD in 17. Of the 47 dead from AMI, 6 died <12 hours ATLD, 35 died >24 hours ATLD and 23 died >48 hours ATLD. CAC values scatter did not allow for analysis but baseline CAC values were higher in the AMI/SD patients vs surviving patients. Conclusions: This is the first report to show a scalable direct relationship between translational PWV and mortality in ESRD. Penultimate PWV, more than baseline PWV predicted mortality. Higher ESRD deaths from AMI/SD occurred during the long interdialytic (weekend) period. We propose that PWV be monitored among all ESRD patients. Patients with high and/or increasing PWV values may require more intense cardiovascular analysis. Further research into new preventative/therapeutic options in this area of ESRD care is warranted.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
