Christopher C Mayer, Pantelis A Sarafidis, Julia Matschkal, Marieta Theodorakopoulou, Georg Lorenz, Artemios Karagiannidis, Susanne Angermann, Fotini Iatridi, Matthias C Braunisch, Antonios Karpetas, Marcus Baumann, Eva Pella, Uwe Heemann, Siegfried Wassertheurer, Christoph Schmaderer
{"title":"作为心脏功能无创替代指标的波强度测量可预测血液透析患者的死亡率","authors":"Christopher C Mayer, Pantelis A Sarafidis, Julia Matschkal, Marieta Theodorakopoulou, Georg Lorenz, Artemios Karagiannidis, Susanne Angermann, Fotini Iatridi, Matthias C Braunisch, Antonios Karpetas, Marcus Baumann, Eva Pella, Uwe Heemann, Siegfried Wassertheurer, Christoph Schmaderer","doi":"10.1093/ckj/sfae172","DOIUrl":null,"url":null,"abstract":"Background and hypothesis Risk prediction in hemodialysis patients is challenging due to the impact of the dialysis regime on patient's volume status and the complex interplay with cardiac function, comorbidities, and hypertension status. Cardiac function as a key predictor of cardiovascular mortality in hemodialysis patients is challenging to assess in daily routine. Thus, the aim of this study was to investigate the association of a novel, non-invasive relative index of systolic function with mortality and to assess its interplay with volume removal. Methods In total, 558 (373 male/185 female) hemodialysis patients with a median age of 66 years were included in this analysis. They underwent 24-hour ambulatory blood pressure monitoring including wave intensity analysis (i.e. S to D ratio (SDR)). All-cause and cardiovascular mortality served as endpoints, and multivariate, proportional hazards models were used for risk prediction. Intra-dialytic changes were analyzed in tertiles according to ultrafiltration volume. During a follow-up of 37.8 months, 193 patients died (92 due to cardiovascular reasons). Results SDR was significantly associated with all-cause (univariate HR = 1.36 [1.20–1.54]; p < 0.001) and cardiovascular (univariate HR = 1.41 [1.20–1.67]; p < 0.001) mortality. The associations remained significant in multivariate analysis accounting for possible confounders. Changes in SDR from pre-/early- to post-dialytic averages were significantly different for the three ultrafiltration volume groups. Conclusion This study provides well-powered evidence for the independent association of a novel index of systolic function with mortality. Furthermore, it revealed a significant association between intradialytic changes of the measure and intradialytic volume removal.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":3.9000,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Measures of wave intensity as non-invasive surrogate for cardiac function predicts mortality in hemodialysis patients\",\"authors\":\"Christopher C Mayer, Pantelis A Sarafidis, Julia Matschkal, Marieta Theodorakopoulou, Georg Lorenz, Artemios Karagiannidis, Susanne Angermann, Fotini Iatridi, Matthias C Braunisch, Antonios Karpetas, Marcus Baumann, Eva Pella, Uwe Heemann, Siegfried Wassertheurer, Christoph Schmaderer\",\"doi\":\"10.1093/ckj/sfae172\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background and hypothesis Risk prediction in hemodialysis patients is challenging due to the impact of the dialysis regime on patient's volume status and the complex interplay with cardiac function, comorbidities, and hypertension status. Cardiac function as a key predictor of cardiovascular mortality in hemodialysis patients is challenging to assess in daily routine. Thus, the aim of this study was to investigate the association of a novel, non-invasive relative index of systolic function with mortality and to assess its interplay with volume removal. Methods In total, 558 (373 male/185 female) hemodialysis patients with a median age of 66 years were included in this analysis. They underwent 24-hour ambulatory blood pressure monitoring including wave intensity analysis (i.e. S to D ratio (SDR)). All-cause and cardiovascular mortality served as endpoints, and multivariate, proportional hazards models were used for risk prediction. Intra-dialytic changes were analyzed in tertiles according to ultrafiltration volume. During a follow-up of 37.8 months, 193 patients died (92 due to cardiovascular reasons). Results SDR was significantly associated with all-cause (univariate HR = 1.36 [1.20–1.54]; p < 0.001) and cardiovascular (univariate HR = 1.41 [1.20–1.67]; p < 0.001) mortality. The associations remained significant in multivariate analysis accounting for possible confounders. Changes in SDR from pre-/early- to post-dialytic averages were significantly different for the three ultrafiltration volume groups. Conclusion This study provides well-powered evidence for the independent association of a novel index of systolic function with mortality. Furthermore, it revealed a significant association between intradialytic changes of the measure and intradialytic volume removal.\",\"PeriodicalId\":10435,\"journal\":{\"name\":\"Clinical Kidney Journal\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.9000,\"publicationDate\":\"2024-06-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Kidney Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/ckj/sfae172\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Kidney Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ckj/sfae172","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
Measures of wave intensity as non-invasive surrogate for cardiac function predicts mortality in hemodialysis patients
Background and hypothesis Risk prediction in hemodialysis patients is challenging due to the impact of the dialysis regime on patient's volume status and the complex interplay with cardiac function, comorbidities, and hypertension status. Cardiac function as a key predictor of cardiovascular mortality in hemodialysis patients is challenging to assess in daily routine. Thus, the aim of this study was to investigate the association of a novel, non-invasive relative index of systolic function with mortality and to assess its interplay with volume removal. Methods In total, 558 (373 male/185 female) hemodialysis patients with a median age of 66 years were included in this analysis. They underwent 24-hour ambulatory blood pressure monitoring including wave intensity analysis (i.e. S to D ratio (SDR)). All-cause and cardiovascular mortality served as endpoints, and multivariate, proportional hazards models were used for risk prediction. Intra-dialytic changes were analyzed in tertiles according to ultrafiltration volume. During a follow-up of 37.8 months, 193 patients died (92 due to cardiovascular reasons). Results SDR was significantly associated with all-cause (univariate HR = 1.36 [1.20–1.54]; p < 0.001) and cardiovascular (univariate HR = 1.41 [1.20–1.67]; p < 0.001) mortality. The associations remained significant in multivariate analysis accounting for possible confounders. Changes in SDR from pre-/early- to post-dialytic averages were significantly different for the three ultrafiltration volume groups. Conclusion This study provides well-powered evidence for the independent association of a novel index of systolic function with mortality. Furthermore, it revealed a significant association between intradialytic changes of the measure and intradialytic volume removal.
期刊介绍:
About the Journal
Clinical Kidney Journal: Clinical and Translational Nephrology (ckj), an official journal of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association), is a fully open access, online only journal publishing bimonthly. The journal is an essential educational and training resource integrating clinical, translational and educational research into clinical practice. ckj aims to contribute to a translational research culture among nephrologists and kidney pathologists that helps close the gap between basic researchers and practicing clinicians and promote sorely needed innovation in the Nephrology field. All research articles in this journal have undergone peer review.