CHA2DS2-VASc Score as a Predictor of Cardiovascular and All-Cause Mortality in Chronic Kidney Disease Patients

2021 ◽  
pp. 1-8
Author(s):  
Nina Vodošek Hojs ◽  
Robert Ekart ◽  
Sebastjan Bevc ◽  
Nejc Piko ◽  
Radovan Hojs
Keyword(s):  
Chronic Kidney Disease ◽  
Regression Analysis ◽  
Kidney Disease ◽  
Cox Regression ◽  
Smoking Status ◽  
High Sensitivity ◽  
Cox Regression Analysis ◽  
Reactive Protein ◽  
All Cause Mortality

<b><i>Introduction:</i></b> Chronic kidney disease (CKD) is a risk factor for cardiovascular and all-cause mortality. Recognition of high-risk patients is important and could lead to a different approach and better treatment. The CHA<sub>2</sub>DS<sub>2</sub>-VASc score was originally used to predict cerebral infarction in patients with atrial fibrillation (AF), but it is also a useful predictor of outcome in other cardiovascular conditions, independent of AF. Therefore, the aim of our research was to assess the role of CHA<sub>2</sub>DS<sub>2</sub>-VASc score in predicting cardiovascular and all-cause mortality in CKD patients. <b><i>Methods:</i></b> Stable nondialysis CKD patients were included. At the time of inclusion, medical history data and standard blood results were collected and CHA<sub>2</sub>DS<sub>2</sub>-VASc score was calculated. Patients were followed till the same end date, until kidney transplantation or until their death. <b><i>Results:</i></b> Eighty-seven CKD patients were included (60.3 ± 12.8 years, 66% male). Mean follow-up time was 1,696.5 ± 564.6 days. During the follow-up, 21 patients died and 11 because of cardiovascular reasons. Univariate Cox regression analysis showed that CHA<sub>2</sub>DS<sub>2</sub>-VASc score is a significant predictor of cardiovascular and all-cause mortality. In multivariate Cox regression analysis, in which CHA<sub>2</sub>DS<sub>2</sub>-VASc score, serum creatinine, urinary albumin/creatinine, hemoglobin, high-sensitivity C-reactive protein, and intact parathyroid hormone were included, CHA<sub>2</sub>DS<sub>2</sub>-VASc score was an independent predictor of cardiovascular (HR: 2.04, CI: 1.20–3.45, <i>p</i> = 0.008) and all-cause mortality (HR: 2.06, CI: 1.43–2.97, <i>p</i> = 0.001). The same was true after adding total cholesterol, triglycerides, and smoking status to both the analyses. <b><i>Conclusion:</i></b> The CHA<sub>2</sub>DS<sub>2</sub>-VASc score is a simple, practical, and quick way to identify the risk for cardiovascular and all-cause mortality in CKD patients.

scholarly journals MO159CHA2DS2-VASC SCORE AS A PREDICTOR OF CARDIOVASCULAR MORTALITY IN CHRONIC KIDNEY DISEASE PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Nina Vodošek Hojs ◽  
Robert Ekart ◽  
Sebastjan Bevc ◽  
Nejc Piko ◽  
Radovan Hojs
Keyword(s):  
Chronic Kidney Disease ◽  
Regression Analysis ◽  
Cardiovascular Risk ◽  
Kidney Disease ◽  
Cardiovascular Mortality ◽  
Cox Regression ◽  
High Sensitivity ◽  
Cardiovascular Death ◽  
Cox Regression Analysis

Abstract Background and Aims Cardiovascular mortality is high in chronic kidney disease (CKD) patients. Recognizing patients with higher cardiovascular risk might help in their treatment. CHA2DS2-VASc score was originally used to predict cerebral infarction in patients with atrial fibrillation (AF). However, it is also useful in predicting outcome in different cardiovascular conditions, independent of the presence of AF. Therefore, the aim of our research was to assess the role of CHA2DS2-VASc score in cardiovascular mortality in CKD patients. Method Eighty-seven non-dialysis CKD patients from our outpatient clinic were included. At the time of inclusion, medical history data and standard blood results were collected and CHA2DS2-VASc score was calculated. Patients were followed for assigned time or until their death. Mean follow-up time was 1696.45±564.60 days. Results Descriptive statistics of our patients are presented in table 1. During follow-up 11 patients suffered from cardiovascular death. Univariate Cox regression analysis showed that CHA2DS2-VASc score is a significant predictor of cardiovascular mortality (HR: 2.19, CI: 1.42-3.37, p=0.001). In multivariate Cox regression analysis in which CHA2DS2-VASc score, serum creatinine, urinary albumin/creatinine, haemoglobin, high sensitivity CRP and intact PTH were included, CHA2DS2-VASc score was an independent predictor of cardiovascular mortality (HR: 2.04, CI: 1.20-3.45, p=0.008) (table 2). Conclusion CHA2DS2-VASc score is a simple and quick way to identify cardiovascular risk in CKD patients.

P1885Cha2ds-2vasc score lacks of ability to predict mortality in patients attending the emergency department with atrial fibrillation in the presence of troponin i

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M I Gonzalez Del Hoyo ◽  
G Cediel ◽  
A Carrasquer ◽  
G Bonet ◽  
K Vasquez-Nunez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Emergency Department ◽  
Regression Analysis ◽  
Troponin I ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
All Cause Mortality

Abstract Background CHA2DS2-VASc score has been used as a surrogate marker for predicting outcomes beyond thromboembolic risk in patients with atrial fibrillation (AF). Likewise, cardiac troponin I (cTnI) is a predictor of mortality in AF. Purpose This study aimed to investigate the association of cTnI and CHA2DS2-VASc score with long-term prognosis in patients admitted to the emergency department with AF. Methods A retrospective cohort study conducted between January 2012 and December 2013, enrolling patients admitted to the emergency department with AF and having documented cTnI measurements. CHA2DS2-VASc score was estimated. Primary endpoint was 5-year all-cause mortality, readmission for heart failure (HF), readmission for myocardial infarction (MI) and the composite end point of major adverse cardiac events defined as death, readmission for HF or readmission for MI (MACE). Results A total of 578 patients with AF were studied, of whom 252 patients had elevated levels of cTnI (43.6%) and 334 patients had CHA2DS2-VASc score >3 (57.8%). Patients with elevated cTnI tended to be oldercompared with those who did not have cTnI elevation and were more frequently comorbid and of higher ischemic risk, including hypertension, prior MI, prior HF, chronic renal failure and peripheral artery disease. The overall median CHA2DS2-VASc score was higher in those with cTnI elevation compared to those patients elevated cTnI levels (4.2 vs 3.3 points, p<0.001). Main diagnoses at hospital discharge were tachyarrhythmia 30.3%, followed by heart failure 17.7%, respiratory infections 9.5% and acute coronary syndrome 7.3%. At 5-year follow-up, all-cause death was significantly higher for patients with cTnI elevation compared with those who did not have cTnI elevation (56.4% vs. 27%; logrank test p<0.001). Specifically, for readmissions for HF and readmissions for MI there were no differences in between patients with or without cTnI elevation. In addition, MACE was reached in 165 patients (65.5%) with cTnI elevation, compare to 126 patients (38.7%) without cTnI elevation (p<0.001). On multivariable Cox regression analysis, cTnI elevation was an independent predictor of all-cause death (hazard ratio, 1.67, 95% confidence interval [CI]: 1.24–2.26, p=0.001) and of MACE (hazard ratio 1.47, 95% confidence interval 1.15–1.88; P=0.002), but it did not reach statistical significance for readmissions for MI and readmissions for HF. CHA2DS2-VASc score was a predictor on univariate Cox regression analysis for each endpoint, but it did not reach significance on multivariable Cox regression analysis for any endpoint. Conclusions cTnI is independently associated with long-term all-cause mortality in patients attending the emergency department with AF. cTnI compared to CHA2DS2-VASc score is thus a biomarker with predictive capacity for mortality in late follow-up, conferring utility in the risk stratification of patients with atrial fibrillation.

scholarly journals Ultrafiltration rate and diabetes as useful indicators of cardiovascular-related death in hemodialysis patients below 60 years of age

2017 ◽  
Vol 71 (0) ◽  
pp. 0-0
Author(s):  
Marcin Krzanowski ◽  
Katarzyna Krzanowska ◽  
Artur Dziewierz ◽  
Małgorzata Banaszkiewicz ◽  
Artur Jurczyszyn ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Cox Regression ◽  
Mortality Data ◽  
Cox Regression Analysis ◽  
Time To Death ◽  
All Cause Mortality ◽  
Dm Type 2 ◽  
Related Mortality

Background: The survival rate of elderly hemodialyzed (HD) patients is commonly thought to be poor. In a prospective, single center, non-interventional, observational study, the cause of all-cause and cardiovascular (CV) and heart failure (HF) mortality in this patient group were examined and compared with a younger cohort (below 60 years). Material/Methods: The study included 223 patients (90 women and 133 men) with age ranging from 34.5 to 75.0 years treated with HD. Median duration of HD was 70.0 months (24.0-120.0). Mortality data was collected over a period of six years. We divided patients into groups: <60 (n=123), ≥60 years (n=100), and with (n=33) and without DM type 2 (n=190). Results: During a six-year follow-up, 100 patients (44.8%) died, including 83 (37.2%) patients who died due to CV reasons. Median follow-up was 2015.0 days (946.0-2463.0) with the median time to death of 1166.0 days (654.5-1631.0). The factors negatively affecting patients’ survival in univariate Cox regression analysis included for all-cause mortality were: inter-dialytic weight gain (IDWG) (hazard ratio [HR]=1.60; p=0.01), ultrafiltration (UF) rate (HR=3.63; p=0.012) for group <60 years; for CV death: UF rate (HR=4.20; p=0.03), DM (HR=5.11; p=0.002) for group <60 years; for HF death: mellitus type 2 (DM) (HR=2.93; p=0.027) for group ≥60 years). In a multivariate Cox regression analysis for patients <60 years, the UF rate was the only independent predictor of all-cause mortality (HR 3.63 (1.34-9.67); p=0.011). Both DM (HR 4.91 (1.71-14.10); p=0.003) and UF rate (HR 3.62 (1.04-12.61); p=0.044) were independent predictors of CV-related mortality in patients <60 years. Conclusions: The UF rate can be a simple, useful indicator of higher long-term all-cause and CV mortality in HD patients <60 years of age. Also, DM may be a predictor of CV–related mortality in younger HD patients.

scholarly journals P1787 Pharmacologic stress test: still an important prognostic factor? a follow-up study

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
V Ferreira ◽  
L Moura Branco ◽  
A Galrinho ◽  
P Rio ◽  
S Aguiar Rosa ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Cox Regression ◽  
Stress Test ◽  
Bypass Graft ◽  
Dobutamine Stress ◽  
Left Ventricular ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
All Cause Mortality

Abstract Introduction Dobutamine stress echocardiography (DSE) is an established exam for evaluation of extent and severity of coronary artery disease. Purpose To analyse the results and complications of DSE and identify prognostic predictors in patients (P) who underwent DSE for myocardial ischemia detection. Methods 220P who underwent consecutive DSE from 2013 to 2017. P with significant valvular disease were excluded. Clinical data, echocardiographic parameters and data from follow up (FU) regarding all-cause mortality and MACEs were analysed. Mean age 64.8 ± 12.0 years(Y), 143 men (65%). Results 88P (40%) had positive, 102 had negative and 30 had inconclusive DSE; complications rate of 15%. Prevalence of hypertension, diabetes mellitus (DM), dyslipidemia, prior MI, percutaneous coronary interventionc (PCI), coronary arterial bypass graft (CABG) and HF was 82.7%, 42.3%, 67.7%, 35.9%, 31.8%, 10.9% and 9.5%, respectively. Mean left ventricular endsystolic (LVSD) and enddiastolic dimensions were 33.7 ± 8.9 and 52.8 ± 7.1 mm. Mean resting wall motion score index (rWMSI) and peak (pWMSI) were 1.16 ± 0.28 and 1.24 ± 0.34. Mean resting GLS (rGLS) and peak GLS (pGLS) were -16.3 ± 4.3 and -16.6 ± 4.3. Mean no. of ischemic segments was 1.7 ± 2.4 and 16.8% had ischemia &gt;3 segments. There was ischemia in left anterior descending (LAD) coronary in 53P and in circumflex and right coronary territories in 18 and 68P. 22.6% had more than one ischemic territory. 43P (49.4%) underwent intervention, 38 with PCI and 5 with CABG. During a mean FU of 38.8 ± 16.8 months, 47 MACEs were observed, including 32 deaths (14.5%). Positive DSE (p = 0.012), no. of ischemic segments (p = 0.019), ischemia in the LAD (p = 0.003), rGLS (p = 0.038) and pGLS (p = 0.038) were related to the occurrence of MACEs. In Cox regression analysis, age (p = 0.005), DM (p = 0.005), HF (p = 0.006), prior CABG (p = 0.015), LVSD (p = 0.026), rWMSI (p = 0.029), pWMSI (p = 0.013) and pGLS (p = 0.038) were associated with increased all-cause mortality. Kaplan–Meier survival analysis showed that survival was significantly worse for ischemia &gt; 3 segments (log rank 0.005), ischemia of more than one territory (log rank 0.025) and pWMSI &gt;1.5 (log rank &lt; 0.0005). With multivariate Cox regression analysis, age &gt;65Y (HR 4.22, p = 0.004), DM (HR 2.49,p = 0.038) and pWMSI &gt; 1.5 (HR 9.73,p = 0.007) were independently associated with all-cause mortality. Conclusion In patients who underwent DSE there were some baseline and DSE-related independent predictors of long-term prognosis: age, DM and peak WMSI. Abstract P1787 Figure. Kaplan–Meier curves

scholarly journals Active smoking is associated with higher rates of incomplete wound healing after endovascular treatment of critical limb ischemia

2020 ◽  
Vol 25 (5) ◽  
pp. 427-435
Author(s):  
Damianos G Kokkinidis ◽  
Stefanos Giannopoulos ◽  
Moosa Haider ◽  
Timothy Jordan ◽  
Anita Sarkar ◽  
...  
Keyword(s):  
Wound Healing ◽  
Regression Analysis ◽  
Cox Regression ◽  
Smoking Status ◽  
Group Versus ◽  
Limb Ischemia ◽  
Active Smoking ◽  
Cox Regression Analysis ◽  
Smoking Group

The association between active smoking and wound healing in critical limb ischemia (CLI) is unknown. Our objective was to examine in a retrospective cohort study whether active smoking is associated with higher incomplete wound healing rates in patients with CLI undergoing endovascular interventions. Smoking status was assessed at the time of the intervention, comparing active to no active smoking, and also during follow-up visits at 6 and 9 months. Cox regression analysis was conducted to compare the incomplete wound healing rates of the two groups during follow-up. A total of 264 patients (active smokers: n = 41) were included. Active smoking was associated with higher rates of incomplete wound healing in the 6-month univariate Cox regression analysis (hazard ratio (HR) for incomplete wound healing: 4.54; 95% CI: 1.41–14.28; p = 0.012). The 6-month Kaplan–Meier (KM) estimates for incomplete wound healing were 91.1% for the active smoking group versus 66% for the non-current smoking group. Active smoking was also associated with higher rates of incomplete wound healing in the 9-month univariable (HR for incomplete wound healing: 2.32; 95% CI: 1.11–4.76; p = 0.026) and multivariable analysis (HR for incomplete wound healing: 9.09; 95% CI: 1.06–100.0; p = 0.044). The 9-month KM estimates for incomplete wound healing were 75% in the active smoking group versus 54% in the non-active smoking group. In conclusion, active smoking status at the time of intervention in patients with CLI is associated with higher rates of incomplete wound healing during both 6- and 9-month follow-up.

scholarly journals The Value of Blood Urea Nitrogen in the Prediction of Risks of Cardiovascular Disease in an Older Population

2021 ◽  
Vol 8 ◽  
Author(s):  
Qin Lan ◽  
Liang Zheng ◽  
Xiaohui Zhou ◽  
Hong Wu ◽  
Nicholas Buys ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Regression Analysis ◽  
Kidney Disease ◽  
Blood Urea Nitrogen ◽  
Cox Regression ◽  
Older Population ◽  
Urea Nitrogen ◽  
Cox Regression Analysis ◽  
Increased Risk

Background: High blood urea nitrogen (BUN) is associated with adverse outcomes in patients with cardiac disease risks. However, no study has explored whether BUN can predict the risk of cardiovascular disease (CVD) in the healthy older population. This study aims to explore the incidence and risk factors of CVD among a healthy older population community in China.Design and Methods: This study was designed as a cohort study with a 4-year follow-up. We recruited 5,000 older people among 137,625 residents of the Gaohang community. In the baseline, subjects were asked to participate in medical screening and biological tests, and answered survey questions. During the follow-up period (2014–2017), the researchers regularly tested the subjects' indicators and assessment scales. We monitored the occurrence of CVD and explored the relationship between BUN and CVD via a Cox regression analysis.Results: During the follow-up, subjects were newly diagnosed with CVD including heart failure (HF), heart disease events, atrial fibrillation, diabetes, hypertension, metabolic syndrome, and kidney disease. The Cox regression analysis found an association between baseline BUN and incident CVD in female subjects, with higher BUN associated with increased risk of AF in females and kidney disease in both male and females. No association was found between BUN and CVD in male subjects.Conclusions: Current results indicate that BUN is a valuable predictive biomarker of CVD. A higher BUN level (&gt;13.51 mg/dL) is associated with an increased occurrence of HF but a decreased occurrence of diabetes and metabolic symptoms in normal older females.

scholarly journals Association of rs11780592 Polymorphism in the Human Soluble Epoxide Hydrolase Gene (EPHX2) with Oxidized LDL and Mortality in Patients with Diabetic Chronic Kidney Disease

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Stefanos Roumeliotis ◽  
Athanasios Roumeliotis ◽  
Aikaterini Stamou ◽  
Stylianos Panagoutsos ◽  
Vangelis G. Manolopoulos ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Epoxide Hydrolase ◽  
Cox Regression ◽  
Oxidized Ldl ◽  
Intima Media Thickness ◽  
Soluble Epoxide Hydrolase ◽  
Cox Regression Analysis ◽  
Functional Polymorphisms ◽  
All Cause Mortality

Soluble epoxide hydrolase 2 (EPHX2) is an enzyme promoting increased cellular apoptosis through induction of oxidative stress (OS) and inflammation. The EPHX2 gene which encodes soluble EPHX2 might be implicated in the pathogenesis and development of OS and atherosclerosis. We aimed to assess the possible association between two functional polymorphisms of the EPHX2 gene (rs2741335 and rs11780592) with oxidized LDL (ox-LDL), carotid atherosclerosis, mortality, and cardiovascular (CV) disease in 118 patients with diabetic chronic kidney disease (CKD). At baseline, ox-LDL and carotid intima-media thickness (cIMT) were evaluated and all patients were followed for seven years with outcomes all-cause mortality and CV events. rs11780592 EPHX2 polymorphism was associated with ox-LDL, cIMT, albuminuria, and hypertension. Compared to AG and GG, AA homozygotes had higher values of albuminuria, ox-LDL, and cIMT ( p = 0.046 , p = 0.003 , and p = 0.038 , respectively). These associations remained significant, even after grouping for the G allele. After the follow-up period, 42/118 patients died (30/60 with AA genotype, 11/42 with AG genotype, and 1/12 with GG genotype) and 49/118 experienced a new CV event (fatal or nonfatal). The Kaplan-Meier analysis revealed that patients with the AA genotype exhibited a significantly higher mortality risk, compared to patients with AG and GG genotypes ( p = 0.006 ). This association became even stronger, when AG and GG genotypes were grouped (AA vs. AG/GG, p = 0.002 ). AA homozygotes were strongly associated with all-cause mortality in both univariate (hazard ratio HR = 2.74 , confidence interval CI = 1.40 – 5.35 , p = 0.003 ) and multivariate Cox regression analysis ( HR = 2.61 , CI = 1.32 – 5.17 , p = 0.006 ). In conclusion, our study demonstrated that genetic variations of EPHX2 gene were associated with increased circulating ox-LDL, increased cIMT, and all-cause mortality in diabetic CKD. Since EPHX2 regulates the cholesterol efflux and the oxidation of LDL in foam cells and macrophages, our study suggests that a genetic basis to endothelial dysfunction and OS might be present in diabetic CKD.

scholarly journals Pacemaker Therapy in the Elderly and Very Elderly

2021 ◽  
pp. 1-3
Author(s):  
Alexander Marschall ◽  
Alexander Marschall ◽  
Andrea Rueda Liñares ◽  
Belen Biscotti Rodil ◽  
Montserrat Torres Lopez ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Prognostic Factors ◽  
Kidney Disease ◽  
Elderly Patients ◽  
Cox Regression ◽  
The Elderly ◽  
Very Elderly ◽  
Pacemaker Therapy ◽  
All Cause Mortality

Background: The number of elderly patients undergoing pacemaker (PM) implantation is constantly growing. However, information on survival and prognostic factors of this particular patient group is scarce. The objective of this study was to determine the survival of elderly and very elderly patients undergoing PM implantation, as well as to investigate prognostic factors of mortality. Methods: This is a retrospective observational study of a single center. Patients ≥ 80 years of age, that underwent PM implantation between January 2017 and December 2018 in our center, were included for chart review. Very elderly patients were defined as those with ≥ 90 years of age. Results: A total of 269 patients were included in the study with a mean age of 85 (±4.1) years. 53 patients were ≥ 90 years of age. 52% of the patients were male. 24.5% of the elderly patients and 41.5% of the very elderly patients received a single chamber PM. Median follow-up time was 28 (14-30) months, with no significant differences between the two groups of patients. The mortality rate for elderly patients was 15.7% for the elderly and 32.1% for the very elderly (p = 0.002). Generating multivariate Cox regression models, the following parameters showed to be significant predictors of all-cause mortality: Age (1.37 (1.02-1.29), p = 0.005), chronic kidney disease (5.57 (2.47-12.56), p<0.001), COPD (3.74 (1.19-11.55), p = 0.023) and cancer (3.57 (1.02-12.51), p = 0.046). In the group of the very elderly only age (1.58 (1.10-2.27), p = 0.014) and cancer (3.76 (2.38-4.18), p = 0.003) significantly predicted mortality. Conclusion: Our study shows a good life expectancy of elderly and very elderly patients that underwent PM implantation, with a survival rate that is comparable to the general population. The primary prognostic factors were non-cardiological and comorbidities, such as chronic kidney disease, cancer and COPD, had a stronger association with mortality than age.

MO820INTRACELLULAR WATER BEFORE HEMODIALYSIS PREDICTS ALL-CAUSE MORTALITY IN HEMODIALYSIS PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Robert Ekart ◽  
Gasper Keber ◽  
Nina Vodošek Hojs ◽  
Eva Jakopin ◽  
Nejc Piko ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Regression Analysis ◽  
Cox Regression ◽  
Volume Status ◽  
Dialysis Patients ◽  
Cox Regression Analysis ◽  
Dialysis Vintage ◽  
All Cause Mortality ◽  
Before And After

Abstract Background and Aims Several factors may be responsible for the increased mortality in dialysis patients, but volume overload is considered among the main mechanisms of this association. Volume status is usually estimated using clinical criteria, i.e., patien's signs and symptoms, peridialytic blood pressure measurements, and intradialytic hemodynamic instability. Bioimpedance analysis (BIA) is another way to measure volume status in dialysis patients. BIA can measure overhydration (OH), extracellular water (ECW), intracellular water (ICW) and ECW/ICW ratio. The aim of our study was to analyze the role of BIA parameters before and after hemodialysis (HD) on all-cause mortality. Method Eighty-three patients (mean age 64.2 years; 51 men) on maintenance HD were included. BIA was performed and blood pressure was measured before and after the HD session. Patients were followed for assigned time, until transplantation or death. The mean follow-up time was 1181±564 days. Results Descriptive statistics of our patients are shown in Table 1. During the follow-up period, 6 (7.2%) patients were transplanted and 39 (47%) patients died. Univariate Cox regression analysis showed that only ICW before HD was a significant predictor of all-cause mortality (HR=1.089; 95%CI: 1.01-1.17, p=0.018). OH, ECW, ECW/ICW ratio before and after HD and ICW after HD were not associated with survival. In multivariate Cox regression analysis including ICW before dialysis, age, dialysis vintage, pulse pressure before HD, hemoglobin, CRP and serum albumin, ICW before dialysis was an independent predictor of all-cause mortality (HR=1.102; 95%CI: 1.01-1.20, p=0.029) (Table 2). Conclusion ICW before HD predicts all-cause mortality in HD patients.

scholarly journals Loss of the Normal Gradient in Arterial Compliance and Outcomes of Chronic Kidney Disease Patients

2019 ◽  
Vol 9 (5) ◽  
pp. 297-307
Author(s):  
Qiong Bai ◽  
Chun-Yan Su ◽  
Ai-Hua Zhang ◽  
Tao Wang ◽  
Wen Tang
Keyword(s):  
Patient Outcome ◽  
Chronic Kidney Disease ◽  
Regression Analysis ◽  
Kidney Disease ◽  
Cox Regression ◽  
Arterial Compliance ◽  
Prognostic Significance ◽  
Significant Interaction Effect ◽  
Cox Regression Analysis ◽  
Ckd Stage

Background: In dialysis patients, loss of the normal gradient in arterial compliance, assessed by the pulse wave velocity (PWV) ratio, predicts all-cause mortality better than does carotid-femoral PWV (CF-PWV) alone. However, the prognostic significance of the PWV ratio for outcome in chronic kidney disease (CKD) patients remains unclear. Methods: In this longitudinal cohort study, CKD patients who visited our CKD management clinic between April 27, 2006, and March 27, 2008, were included and followed up. To assess the gradient in arterial compliance, the PWV ratio was calculated using CF-PWV divided by carotid-radial PWV. Results: A total of 209 patients in CKD stages 1–4 with a median follow-up of 3.74 years were included. Patients with higher PWV ratio were relatively older (p < 0.001) and had worse renal function (p < 0.001), more hypertension (p < 0.001), diabetes mellitus (p < 0.001), and cardiovascular or cerebrovascular disease (p < 0.001). The median time to patient outcome (death, renal replacement therapy, or double increase in serum creatinine from baseline) in the group with a PWV ratio above the median (89.8 months, 95% CI 84.2–95.5) was shorter than that in the group with a PWV ratio below the median (105.3 months, 95% CI 101.3–109.3, p = 0.001). Univariate Cox regression analysis showed that both PWV ratio and CF-PWV were significantly associated with patient outcome. In multivariate Cox regression analysis, both PWV ratio and CF-PWV were associated with patient outcome. However, the HR for CF-PWV (2.177, 95% CI 1.064–4.453, p = 0.033) was slightly higher than that for PWV ratio (2.091, 95% CI 1.049–4.167, p = 0.036). There was a significant interaction effect between PWV ratio and CKD stage. It was shown that patients with advanced CKD stages and higher PWV ratios had a significantly higher risk of adverse CKD outcome (p = 0.006). Conclusions: The PWV ratio, as a measure of loss of the normal gradient in arterial compliance, was associated with CKD patient outcome. Patients with advanced CKD and a higher PWV ratio had a significantly higher risk of adverse CKD outcome.

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