Integrated Central Blood Pressure-Aortic Stiffness Risk Categories and Cardiovascular Mortality in End-Stage Renal Disease

Abstract

Background: Our aim was to study the predictive power of integrated central blood pressure-aortic stiffness (ICPS) risk categories on cardiovascular (CV) mortality in end-stage renal disease (ESRD) patients. Methods: This is a secondary analysis of a prospective study of 91 ESRD patients on hemodialysis therapy. At baseline, pulse wave velocity (PWV), central systolic blood pressure (cSBP) and central pulse pressure (cPP) were measured and patients were followed up for CV mortality for a median 29.5 months. Based on the shape of the association of each individual ICPS parameter with the CV outcome, patients were assigned ICPS scores: one point was given, if either the cSBP value was in the 3rd, or if the PWV or cPP was in the 2nd or 3rd tertiles (ICPS range: 0-3). We then evaluated the role of ICPS risk categories (average: 0-1, high: 2, very high: 3 points) in the prediction of CV outcomes using Cox proportional hazard regression analysis and compared its discrimination (Harrell's C) to that of each of its components. Results: We found a strong dose-response association between ICPS risk categories and CV outcome (high risk HR = 2.62, 95% CI: 0.82-8.43, p for trend = 0.106; very high risk HR = 10.03, 95% CI: 1.67-60.42, p = 0.02) even after adjustment for multiple potential confounders. ICPS risk categories had a modest discrimination (C: 0.622, 95% CI: 0.525-0.719) that was significantly better than that of cSBP (dC: 0.061, 95% CI: 0.006-0.117). Conclusion: The ICPS risk categories may improve the identification of ESRD patients with high CV mortality risk. H I G H L I G H T S • Integrated evaluation of central blood pressure and stiffness (ICPS) may improve risk prediction. • ICPS risk categories were developed and tested in end-stage renal disease (ESRD). • Very high ICPS risk category is a strong predictor of cardiovascular mortality in ESRD.