Pulse Wave Velocity and Prognosis in End-Stage Kidney Disease

Abstract

High pulse wave velocity (PWV) is a hallmark of end-stage kidney disease (ESKD) where it is considered useful for risk stratification. We investigated whether PWV adds meaningful prognostic information to 2 simple, well-validated, clinical risk scores specific to ESKD (the Annualized Rate of Occurrence scores) for predicting all-cause and cardiovascular mortality by applying state-of-the-art prognostic tests including discrimination (Harrell C-index), risk reclassification (integrated discrimination improvement), and calibration. We performed these analyses in the 2 largest ESKD cohorts with available PWV data, the Manhes-Hospital cohort in Paris (n=287 patients) and the Quebec Research Center cohort in Canada (n=246 patients). The Harrell C-index of the 2 clinical risk scores was consistently higher than that by PWV both for all-cause (Manhes cohort, 77.5% versus 73.7%; Quebec cohort, 61.5% versus 58.9%) and cardiovascular mortality (Manhes cohort, 77.9% versus 77.2%; Quebec cohort, 63.8% versus 60.3%). Furthermore, PWV provided a very modest increase in discriminatory power over and above clinical risk scores by Harrell C-index (from 0.5% to 1.8%) and in risk reclassification by Integrated Discrimination Improvement (from 0.9% to 5.1%) and actually worsened models calibration. In patients with ESKD, PWV has a prognostic power for all-cause and cardiovascular mortality inferior to that by simple clinical risk scores and only modestly improves the risk discrimination and reclassification by the same risk scores and worsens models calibration. Clinicians may better rely on available clinical risk scores rather than on PWV for risk stratification in the ESKD population.

Ankle‐brachial index, arterial stiffness, and biomarkers in the prediction of mortality and outcomes in patients with end‐stage kidney disease

“…baPWV has been reported to be correlated with the direct measure of aortic PWV and carotid‐femoral PWV, which has been shown to be a strong predictor of mortality in ESKD patients . However, because of technical issues such as measurement protocols and reproducibility, the use of baPWV for the accurate risk prediction of ESKD patients is still discussed . Ho‐Ming, et al showed that the ba‐PWV measurements were influenced by blood volume changes after HD sessions, whereas ABI was not .…”

“…However, measurements of baPWV can be influenced by the presence of PAD and hemodynamic condition after hemodialysis (HD) session . Therefore, the prognostic value of baPWV in ESKD patients is still discussed …”

“…[11][12][13] Therefore, the prognostic value of baPWV in ESKD patients is still discussed. 14 With the widespread clinical application of standardized assays, several biomarkers and multiple biomarker approach enable the accurate prediction of the long-term prognosis of ESKD patients treated with HD. [15][16][17] Previous studies have demonstrated that cardiac troponin (cTn), brain-natriuretic peptide (BNP), and C-reactive protein (CRP) are the robust predictors of MACE independent of traditional risk factors and two-dimensional thoracic Doppler echocardiography (TTDE) findings.…”

Cardiovascular Risk Assessment Using Ultrasonographic Surrogate Markers of Atherosclerosis and Arterial Stiffness in Patients With Chronic Renal Impairment: A Narrative Review of the Evidence and a Critical View of Their Utility in Clinical Practice

“…By applying state-of-the-art prognostic tests, Tripepi et al have shown that the modest effect of PWV on risk discrimination and reclassification over and above clinical risk scores (annualized rate of occurrence scores, ARO scores) does not have a clinically meaningful impact in patients with ESRD on HD. 54 This is an important finding, albeit the limitations of small sample size, the retrospective nature of the reanalysis, the lack of a priori analysis to determine statistical power, and limiting the follow-up time of the studies to match the ARO scores, which are only validated to predict the risk over a period of 2 years. Among nondialysis CKD studies, the Chronic Renal Insufficiency Cohort (CRIC) study is one of the largest cohorts, evaluating the role of arterial stiffness.…”

Disability of Dialysis Patients and the Condition of Blood Vessels

“…Regardless, PWV is a useful, non-invasive, diagnostic and prognostic tool for the prediction of cardiovascular disease in the CKD population; however as a mortality predictor, it may not necessary show superior usefulness comparing to other validated clinical risk scores. Recent comparison of PWV vs. annualized rate of occurrence (ARO) risk score in patients with ESRD indicate that PWV has inferior prognostic power for all-cause and cardiovascular mortality compared to ARO risk score [ 21 , 22 ]. Additional data point that 24-h PWV may have a higher prediction value than PWV in the office setting for all-cause-mortality in hemodialysis patients [ 23 ].…”