NDT Advance Access published online on August 17, 2007
Nephrology Dialysis Transplantation, 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 and offprint requests 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