Abstract-To test the predictive values of and independent contributions to cardiovascular and all-cause mortality of various arterial parameters exploring characteristics of the arterial wall at different sites, we studied prospectively 110 stable end-stage renal disease patients on hemodialysis. These parameters involved carotid diameter, carotid intima-media thickness, carotid compliance, carotid distensibility, carotid incremental elastic modulus, aortic diameter, aortic pulse wave velocity, and the presence of arterial calcifications measured at the sites of the carotid artery, abdominal aorta, iliofemoral axis, and legs. The presence of calcifications was analyzed semiquantitatively as a score (0 to 4) according to the number of arterial sites with calcifications. During a follow-up of 53Ϯ21 months (meanϮSD), 25 cardiovascular and 14 noncardiovascular deaths occurred. In univariate analysis, the carotid incremental elastic modulus was the most closely related to prognosis. Risk of death increased with the number of vascular sites involved by calcifications. Moreover, information (in terms of prediction) given by carotid elastic incremental modulus was additive to the presence and extent of vascular calcification-related prediction value. Adjusted hazard ratios of all-cause and cardiovascular mortality for an increase of 1 unit in calcification score were 1.9 (95% confidence interval [CI], 1.4 to 2.6) and 2.6 (95% CI, 1.5 to 4.4), respectively (PϽ0.001 for both). Adjusted hazard ratios of all-cause and cardiovascular mortality for a 1-SD increase in carotid incremental elastic modulus were 1.6 (95% CI, 1.2 to 2.2) and 1.7 (95% CI, 1.2 to 2.4), respectively (PϽ0.01 for both). 4 It has recently been reported that the presence of vascular calcifications in end-stage renal disease (ESRD) patients was associated with increased stiffness of large, capacitive, elastic-type arteries like the aorta and common carotid artery (CCA). 4 Because CCA incremental elastic modulus (Einc) and aortic pulse wave velocity (PWV) were both identified as strong predictors of prognosis in ESRD patients 5,6 and because, to the best of our knowledge, no prospective study has reported associations between arterial calcifications and prognosis in ESRD populations, we designed this study to test the predictive value of various arterial parameters exploring characteristics of the arterial wall at different sites. These parameters involved CCA diameter, CCA intima-media thickness (IMT), CCA compliance, CCA distensibility, CCA Einc, aortic diameter, aortic PWV, and the presence of arterial calcifications measured at the sites of the CCA, abdominal aorta, iliofemoral axis, and legs. Subsequently, we examined whether these different parameters had independent contributions to CV and all-cause mortality.
Methods
PatientsPatients were eligible for inclusion if they (1) had been on hemodialysis for Ն3 months (81Ϯ79 months, meanϮSD), (2) had no clinical CV disease during the 6 months preceding entry, and (3) agreed to participate in the follow-up...