NDT Advance Access originally published online on August 17, 2007
Nephrology Dialysis Transplantation 2007 22(12):3527-3532; doi:10.1093/ndt/gfm484
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Pulse wave velocity—a useful tool for cardiovascular surveillance in pre-dialysis patients
1Department of Internal Medicine, Division of Nephrology, 2Department of Radiology, Hospital do Rim e Hipertensão, Federal University of São Paulo, São Paulo, Brazil, 3Lipid Clinic Heart Institute (InCor), University of São Paulo, Medical School Hospital and 4Centro de Diagnóstico Brasil, São Paulo, Brazil
Correspondence to: Maria Eugênia F. Canziani, Rua Pedro de Toledo 282, ZIP 04039-000, São Paulo, Brazil. Email: dialisefor{at}uol.com.br
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Abstract |
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Background. Cardiovascular mortality is high among patients with chronic kidney disease. Pulse wave velocity (PWV) is a simple method used for arterial distensibility evaluation. Few data are available concerning PWV in pre-dialysis patients. The aim of this study was to evaluate the association between PWV and cardiovascular disease in pre-dialysis.
Methods. One hundred and four patients were submitted to PWV analysis, coronary artery calcium (CAC) determination with a multi-slice CT scan of the coronary arteries, echocardiogram and a carotid intima-media thickness (IMT) evaluation, with a high resolution ultrasound. The demographic characteristics and laboratory tests results were studied.
Results. The mean age of those studied was 54.4 ± 11.5 years, 60% were males and the mean creatinine clearance was 40 ml/min/1.73 m2. The mean PWV was 12.2 ± 3.4 m/s and it was significantly higher in males, diabetics, those with creatinine clearance <60 ml/min and proteinuria 
1 g/24 h. PWV was correlated with systolic blood pressure, age, triglycerides, total cholesterol and 24 h proteinuria. In the multiple regression analysis, PWV was significantly associated with diabetes, age, systolic blood pressure and cholesterol. Fifty-eight patients (56%) presented coronary calcification and PWV correlated with coronary calcium score (R = 0.48; P < 0.001) and calcium volume (R = 0.50; P < 0.001). Moreover, PWV was higher in patients with coronary calcification (13.4 ± 3.6 m/s vs 10.7 ± 2.4 m/s; P < 0.001). The mean left ventricular mass index (LVMI) was 106 ± 31 g/m2 and 24% of patients had left ventricular hypertrophy, while 19 (18.3%) patients had left ventricular dysfunction. PVW was correlated with LVMI (R = 0.25; P = 0.01) while no association could be seen between PWV and the ejection fraction or left ventricular dysfunction. A correlation between the IMT and PWV was observed (R = 0.27; P = 0.005). In addition, those with a thicker IMT had a higher PWV (13.2 ± 3.4 m/s vs 11. 2 ± 3.2 m/s; P = 0.003).
Conclusion. PWV is associated with cardiovascular disease in pre-dialysis patients and can be a useful tool to identify patients with increased cardiovascular risk.
Keywords: arterial stiffness; cardiovascular disease; coronary calcification; pulse wave velocity
Received for publication: 10. 2.07
Accepted in revised form: 26. 6.07
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