Arterial stiffness and its impact on prognosis in patients with stage 3-5 chronic kidney disease(pre-dialysis) / 中国实用内科杂志

ABSTRACT

OBJECTIVE: To assess the impact of arterial stiffness on prognosis in patients with chronic kidney disease(CKD)stages 3-5(pre-dialysis).METHODS: 141 patients suffered from chronic kidney disease(CKD)stages 3-5 pre-dialysis were enrolled in this study between April 2006 and November 2010.Automatic pulse wave velocity(PWV)measuring system was used to examine carotid-femoral pulse wave velocity(CFPWV).According to CFPWV level,we divided the patients into elevated CFPWV group(CFPWV ≥12 m/s)and the normal group(CFPWV<12 m/s).Patients were followed up for the occurrence of cardiovascular event,cardiovascular death and all-cause death.Kaplan-Meier methods were used for survival analysis and Cox's proportional hazard regression model were used to analyze risk factors.RESULTS: Two groups were followed-up(93.72±47.93)months.The incidences of cardiac-cerebral vascular event,cardiac-cerebral vascular death and all-cause death were higher in high CFPWV level groups(62.2%vs.21.6%,56.7%vs.15.7%,64.4%vs.19.6%,P<0.05).The level of CFPWV was higher in patients with cardiac-cerebral vascular event,cardiac-cerebral vascular death and all-cause death than those without those events[(15.31±3.41)m/s vs.(12.08±2.94)m/s,(15.66±3.40)m/s vs.(12.14±2.88)m/s,(15.38±3.38)m/s vs.(11.97±2.87)m/s,P<0.01].Kaplan-Meier curve for overall survivals and cardiac-cerebral vascular event free survivals showed a significant distinct between high and normal CFPWV level groups,suggesting that the incidence of cardiac-cerebral vascular events,cardiac-cerebral vascular mortality and all-cause mortality were significantly higher in high CFPWV level group than in normal CFPWV group(P=0.000).Multivariate Cox regression analysis revealed that increased CFPWV and commencing dialysis were the independent risk factors for cardiac-cerebral vascular event,increased CFPWV and CRP and decreased ALB and commencing dialysis were the independent risk factors for cardiac-cerebral vascular mortality and all-cause mortality(P<0.05).CONCLUSION: The levels of CFPWV in pre-dialysis chronic kidney disease(CKD)stage 3-5 patients increases significantly.The incidence of cardiac-cerebral vascular events,cardiac-cerebral vascular mortality and all-cause mortality are significantly higher in elevated CFPWV group than those of normal group in patients with CKD G3-5.The elevated CFPWV is one of independent risk factors of cardiac-cerebral vascular event,cardiac-cerebral vascular mortality and all-cause mortality in patients with pre-dialysis chronic kidney disease.