Seijinaki Mihama Narita Clinic, Narita City, Chiba, 286-0041, Japan.
Seijinkai Mihama Katori Clinic, Katori City, Chiba, 287-0041, Japan.
Vasc Health Risk Manag. 2021 Dec 2;17:791-798. doi: 10.2147/VHRM.S339769. eCollection 2021.
Mortality rate of maintenance hemodialysis patients is known to be high. Cardio-ankle vascular index (CAVI) is an index reflecting the proper stiffness of the arterial tree from the origin of the aorta to the ankle. We aimed to clarify the utility of CAVI as a predictor of mortality in hemodialysis patients. The roles of age and nutritional conditions on survival were also examined.
We followed 242 patients undergoing hemodialysis for 6 consecutive years. Data from 209 patients (mean age was 60 ± 11 years) excluding those with ankle-brachial index <0.90 were then analyzed. CAVI and heart to ankle pulse wave velocity (haPWV) were measured using Vasera 1500.
Thirty-eight hemodialysis patients who died during the 6-year period had higher age, cardiothoracic ratio (CTR), CAVI, and haPWV, and lower diastolic blood pressure, albumin, phosphate, and calcium phosphate product. The Kaplan-Meier curves for cumulative survival among the tertile groups showed that the mortality rate was higher in the highest tertile (T3) compared to T1/T2 for both CAVI and haPWV. Receiver operating characteristic (ROC) analysis revealed that CAVI had better discriminatory power for all-cause mortality compared to haPWV. In the Cox-proportional hazards analyses, 1 SD increase in both parameters contributed independently to all-cause mortality [CAVI: HR 1.595 (95% CI 1.108-2.297), haPWV: HR 1.695 (95% CI 1.185-2.425)], as well as age and CTR. Both parameters above the cut-offs estimated in the ROC analysis (CAVI ≥ 9.2, haPWV ≥ 8.9) also had independent contributions to mortality.
Through the 6 consecutive years of follow-up in 209 HD patients, increased CAVI might represent a major modifiable risk factor for all-cause mortality. Further research is needed to examine whether CAVI-lowering interventions contribute to improved prognosis.
维持性血液透析患者的死亡率众所周知较高。心血管踝动脉指数（CAVI）是反映从主动脉起源到踝部动脉树适当僵硬程度的指标。我们旨在阐明 CAVI 作为血液透析患者死亡率预测指标的作用。还检查了年龄和营养状况对生存率的影响。
我们对 242 例连续 6 年接受血液透析的患者进行了随访。然后分析了 209 例患者（平均年龄为 60±11 岁）的数据，排除了踝臂指数<0.90 的患者。使用 Vasera 1500 测量 CAVI 和心踝脉搏波速度（haPWV）。
在 6 年期间死亡的 38 例血液透析患者年龄、心胸比（CTR）、CAVI 和 haPWV 较高，舒张压、白蛋白、磷酸盐和钙磷乘积较低。CAVI 和 haPWV 三分位组的累积生存率 Kaplan-Meier 曲线显示，最高三分位组（T3）的死亡率高于 T1/T2。受试者工作特征（ROC）分析显示，CAVI 对全因死亡率的判别能力优于 haPWV。在 Cox 比例风险分析中，两个参数的 1 SD 增加均与全因死亡率独立相关[CAVI：HR 1.595（95%CI 1.108-2.297），haPWV：HR 1.695（95%CI 1.185-2.425）]，以及年龄和 CTR。ROC 分析中估计的截点以上的两个参数（CAVI≥9.2，haPWV≥8.9）也与死亡率独立相关。
通过对 209 例血液透析患者连续 6 年的随访，CAVI 的增加可能代表全因死亡率的一个主要可改变的危险因素。需要进一步研究以检查降低 CAVI 是否有助于改善预后。
