Carotid Arterial Stiffness as a Predictor of Cardiovascular and All-Cause Mortality in End-Stage Renal Disease

TLDR

Large‑artery damage contributes to the high pulse pressure seen in end‑stage renal disease, yet whether carotid incremental modulus of elasticity predicts cardiovascular mortality has not been studied. The study followed 79 hemodialysis patients (mean age 58 years) for 25 months, measuring carotid incremental modulus of elasticity from echo‑tracking and tonometry at baseline. Higher carotid E inc and lower diastolic blood pressure independently predicted all‑cause and cardiovascular death, with an odds ratio of 9.2 for E inc ≥ 1 kPa⁻³.

Abstract

Abstract —Damage of large arteries is a major contributory factor to the high pulse pressure observed in patients with end-stage renal disease. Whether incremental modulus of elasticity (E inc ), a classic marker of arterial stiffness, can predict cardiovascular mortality has never been investigated. A cohort of 79 patients with end-stage renal disease undergoing hemodialysis was studied between September 1995 and January 1998. Mean age at entry was 58±15 years. The duration of follow-up was 25±7 months, during which 10 cardiovascular and 8 noncardiovascular fatal events occurred. At entry, carotid E inc was calculated from measurements of diameter, thickness (echo-tracking technique), and pulse pressure (tonometry). Based on Cox analyses, 2 dominant factors emerged as predictors of all-cause and cardiovascular mortality: increased E inc and decreased diastolic blood pressure. Lipid abnormalities and the presence of previous cardiovascular events interfered to a smaller extent. After adjustment for confounding variables, the odds ratio for E inc ≥1 kPa −3 was 9.2 (95% confidence interval, 2.4 to 35.0) for all-cause mortality. These results provide the first direct evidence that in patients with end-stage renal disease undergoing hemodialysis, arterial alterations, as determined from carotid E inc , are strong independent predictors of all-cause and cardiovascular mortality.