Upstroke Time as a Novel Predictor of Mortality in Patients with Chronic Kidney Disease

Abstract

Upstroke time (UT), measured from the foot-to-peak peripheral pulse wave, is a merged parameter used to assess arterial stiffness and target vascular injuries. In this study, we aimed to investigate UT for the prediction of cardiovascular and all-cause mortality in patients with chronic kidney disease (CKD). This longitudinal study enrolled 472 patients with CKD. Blood pressure, brachial pulse wave velocity (baPWV), and UT were automatically measured by a Colin VP-1000 instrument. During a median follow-up of 91 months, 73 cardiovascular and 183 all-cause mortality instances were recorded. Multivariable Cox analyses indicated that UT was significantly associated with cardiovascular mortality (hazard ratio (HR) = 1.010, p = 0.007) and all-cause mortality (HR = 1.009, p < 0.001). The addition of UT into the clinical models including traditional risk factors and baPWV further increased the value in predicting cardiovascular and all-cause mortality (both p < 0.001). In the Kaplan–Meier analyses, UT ≥ 180 ms could predict cardiovascular and all-cause mortality (both log-rank p < 0.001). Our study found that UT was a useful parameter in predicting cardiovascular and all-cause mortality in CKD patients. Additional consideration of the UT might provide an extra benefit in predicting cardiovascular and all-cause mortality beyond the traditional risk factors and baPWV.

Relationship between sex and cardiovascular mortality in chronic kidney disease: A systematic review and meta-analysis

“…23 out of the 48 included studies reported a higher cardiovascular mortality rate in men than women, with risk estimates ranging from 1.16 to 3.51 (Tables 2 and 3 ) [ 18 – 20 , 25 , 30 , 35 , 37 , 38 , 42 , 45 , 55 , 57 , 58 , 60 – 62 ]. However, 18 of the 48 studies showed that men had a lower risk of cardiovascular mortality compared to women, with risk estimates ranging from 0.29 to 0.93 (Tables 2 and 3 ) [ 23 , 24 , 34 , 39 , 44 , 46 , 47 , 49 , 53 , 54 , 59 ].…”

“…The majority of the studies reported results for end-stage renal disease (ESRD) patients on dialysis: 30 studies included subjects exclusively on HD [15,16,19,20,, eight studies included subjects on PD [48][49][50][51][52][53][54][55], three studies included both HD and PD [17,18,56], and six studies reported their subjects were not on dialysis [21,[57][58][59][60][61]. Six studies defined their subjects as having CKD stages 3 to 5, [18,21,58,59,61,62], while only one study described their subjects as CKD stages 3 and 4 [60]. In addition to this, most studies (33/48) reported comorbidity with diabetes mellitus and hypertension.…”

Can Upstroke Time be a More Significant Predictor for Cardiovascular Disease Than Ankle-Brachial Index?

“…The phenomenon of the prolonged UTCC with normal ABI is based on various collateral arterial networks with severe PAD, including chronic total occlusion of peripheral arteries. Based on this background, UTCC has been reported to be a significant parameter for mortality prediction in diseased patients such as type 2 diabetes mellitus 4) , chronic kidney disease 5) , or acute myocardial infarction 6) .…”