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Integrated Central Blood Pressure-aortic Stiffness Risk Categories and Cardiovascular Mortality in End-stage Renal Disease

Artery Research volume 25, pages 49–55 (2019)Cite this article

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.

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Author information

Author notes

  1. These authors contributed equally to this work and are considered shared last authors.

Authors and Affiliations

  1. Department of Family Medicine, Semmelweis University, 4 Kútvölgyi Str., 1125, Budapest, Hungary

    Dóra Batta, Beáta Kőrösi & János Nemcsik

  2. Department of Medicine, Semmelweis University, 2a Korányi Sándor Str., 1083, Budapest, Hungary

    Ádám Tabák & András Tislér

  3. Department of Epidemiology and Public Health, University College London, 1-19 Torrington PL, WC1E 7HB, Fitzrovia, London, UK

    Ádám Tabák

  4. Department of Transplantation and Surgery, Semmelweis University, 23-26 Baross Str., 1082, Budapest, Hungary

    Orsolya Cseprekál

  5. Department of Internal Medicine and Cardiology, Klinikum Klagenfurt, 11 Feschnigstrasse, Klagenfurt am Wörthersee, Austria

    József Egresits

  6. Department of Family Medicine, Health Service of Zugló (ZESZ), 23 Örs vezér sqr., 1148, Budapest, Hungary

    János Nemcsik

Authors
  1. Dóra Batta
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  2. Ádám Tabák
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  3. Beáta Kőrösi
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  4. Orsolya Cseprekál
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  5. József Egresits
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  6. András Tislér
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  7. János Nemcsik
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Corresponding author

Correspondence to János Nemcsik.

Additional information

Highlights

· 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.

Peer review under responsibility of the Association for Research into Arterial Structure and Physiology

Data availability statement: The data that support the findings of this study are available from the corresponding author, upon reasonable request.

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This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).

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Batta, D., Tabák, Á., Kőrösi, B. et al. Integrated Central Blood Pressure-aortic Stiffness Risk Categories and Cardiovascular Mortality in End-stage Renal Disease. Artery Res 25, 49–55 (2019). https://doi.org/10.2991/artres.k.191114.004

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  • DOI: https://doi.org/10.2991/artres.k.191114.004

Keywords

Artery Research

ISSN: 1876-4401

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