Evaluation of carotid intima-media thickness and ultrafast pulse wave velocity for cardiovascular events and all-cause mortality in hemodialysis patients: impact of diabetes.
CIMT is significantly higher in hemodialysis patients compared to controls, but its association with cardiovascular events is not significant after adjusting for diabetes. The findings regarding ufPWV parameters also warrant further investigation.
Where it sits
this study against the rest of the dsip corpusSummary and findings
This study evaluated carotid intima-media thickness (CIMT) and ultrafast pulse wave velocity (ufPWV) in 115 maintenance hemodialysis patients over 39 months. It found that MHD patients had significantly higher CIMT compared to non-ESRD controls (1.60 vs 0.80 mm, p=0.004). The study also recorded 21 cardiovascular events and 17 deaths during follow-up.
Abstract
Arterial remodeling is common in end-stage renal disease (ESRD). This prospective cohort study explored the potential prognostic value of carotid intima-media thickness (CIMT) and ultrafast pulse wave velocity (ufPWV) - including pulse wave velocity at the beginning (PWV-BS) and end of systole (PWV-ES) for cardiovascular (CV) events and all-cause mortality in 115 maintenance hemodialysis (MHD) patients followed for 39 months. Compared with non-ESRD controls, MHD patients exhibited significantly higher CIMT (1.60 vs 0.80 mm, <i>p</i> = 0.004), while ufPWV parameters appeared comparable. During follow-up, 21 CV events and 17 deaths were recorded. In univariable analysis, CIMT was associated with CV events and positively correlated with diabetes (<i>r</i> = 0.271, <i>p</i> = 0.003). However, after adjusting for diabetes, this association was no longer statistically significant (HR 1.350, 95% CI 0.865-2.106, <i>p</i> = 0.186). Neither PWV-BS nor PWV-ES was associated with outcomes in the overall cohort. Preliminary subgroup analysis of patients with diabetes (<i>n</i> = 36, 15 CV events) observed an inverse association between left PWV-ES and CV events. In conclusion, CIMT was no longer significantly associated with CV events after adjustment for diabetes in the limited model, whereas local ufPWV parameters were not significantly associated with CV events or all-cause mortality in the analyses performed within the overall MHD population. Given the issue of multiple comparisons and small sample size, the isolated finding between left PWV-ES and CV events in the diabetic subgroup must be treated strictly as hypothesis-generating, requiring independent validation in a larger cohort.
Background
This study addresses the prognostic value of CIMT and ufPWV in patients with end-stage renal disease (ESRD), a population known to have increased cardiovascular risk. Prior research has indicated that arterial remodeling is prevalent in ESRD, but the specific contributions of CIMT and ufPWV to cardiovascular events and mortality remain unclear. Understanding these relationships could inform risk stratification and management strategies in this high-risk group.
Methods
This prospective cohort study involved 115 maintenance hemodialysis patients followed for 39 months. The primary outcome measures included cardiovascular events and all-cause mortality, with secondary measures assessing CIMT and ufPWV parameters. The study compared these measurements to non-ESRD controls and performed subgroup analyses based on diabetes status.
Results
The primary endpoint revealed that MHD patients had a CIMT of 1.60 mm compared to 0.80 mm in non-ESRD controls (p=0.004). During the follow-up, 21 cardiovascular events and 17 deaths were recorded. CIMT was positively correlated with diabetes (r=0.271, p=0.003), but this association was not significant after adjusting for diabetes (HR 1.350, 95% CI 0.865-2.106, p=0.186). Neither PWV-BS nor PWV-ES was associated with outcomes in the overall cohort.
Interpretation
The findings suggest that while CIMT is higher in MHD patients, its association with cardiovascular events diminishes when adjusted for diabetes, indicating that diabetes may confound this relationship. The lack of significant associations for ufPWV parameters raises questions about their prognostic value in this population. The small sample size and the exploratory nature of the subgroup analysis limit the robustness of the findings and suggest that further research is needed for validation.
Key findings
- CIMT in MHD patients was 1.60 mm vs 0.80 mm in non-ESRD controls, p=0.004.
- 21 cardiovascular events and 17 deaths were recorded during the 39-month follow-up.
- CIMT was positively correlated with diabetes, r=0.271, p=0.003.
- After adjusting for diabetes, the association of CIMT with CV events was no longer statistically significant (HR 1.350, 95% CI 0.865-2.106, p=0.186).
- In the diabetic subgroup (n=36), there was an inverse association between left PWV-ES and CV events.
Limitations
- small sample size (n=115)
- industry funding not reported
- subgroup analysis based on diabetes is hypothesis-generating only
- no significant association of PWV-BS or PWV-ES with outcomes
- follow-up duration of 39 months may not capture long-term outcomes