Individual Components of Central Blood Pressure and Aortic Stiffness versus the Integration of Multiple Components in Predicting Cardiovascular Mortality in End-Stage Renal Disease

Abstract

Abstract Aortic stiffness, measured by carotid-femoral pulse-wave velocity (PWV), is a predictor of cardiovascular (CV) mortality in patients with end-stage renal disease (ESRD). Aortic stiffness increases aortic systolic and pulse pressures (cSBP, cPP) and augmentation index (AIx). In this study, we examined if the integration of multiple components of central blood pressure and aortic stiffness (ICPS) into risk score categories could improve CV mortality prediction in ESRD. In a prospective cohort of 311 patients with ESRD on dialysis who underwent vascular assessment at baseline, 118 CV deaths occurred after a medial follow-up of 3.1 years. The relationship between hemodynamic parameters and CV mortality was analyzed through Kaplan-Meier and Cox survival analysis. ICPS risk score from 0 to 5 points were calculated from points given to tertiles, and were regrouped into three risk categories (Average, High, Very High). A strong association was found between the ICPS risk categories and CV mortality (High risk HR = 2.20, 95%CI: 1.05–4.62, P = 0.036; Very High risk (HR = 4.44, 95%CI: 2.21–8.92, P < 0.001). The very high-risk category remained associated with CV mortality (HR = 3.55, 95% CI: 1.37–9.21, P = 0.009) after adjustment for traditional CV risk factors. While ICPS categories showed higher C-statistics (C: 0.627, 95%CI: 0.578–0.676, P = 0.001), it was not statistically superior to PWV, cPP or AIx. In conclusion, integration of multiple components of central blood pressure and aortic stiffness did not result in a significantly better prediction of CV mortality in this cohort.