Abstract Body: Introduction and Objectives:Patients undergoing dialysis exhibit a significantly higher risk of cardiovascular disease (CVD) and poorer clinical outcomes compared to the non-dialysis population. Recently, a novel device for assessing arterial stiffness has allowed for the non-invasive and simple assessment of two new parameters: brachial artery volume elastic modulus (VE) and estimated area (eA). In the present study, we evaluated the association between these parameters and prognosis in dialysis patients.
Methods and Results:This multicenter prospective observational study included 245 maintenance hemodialysis patients across six dialysis centers. The study population consisted of 157 males (64%) with a mean age of 69 ± 13 years and a mean dialysis vintage of 5.9 ± 6.2 years. Baseline measurements showed blood pressure of 143 ± 23 / 78 ± 13 mmHg, corrected calcium of 9.2 ± 0.8 mg/dL, phosphorus of 5.4 ± 2.7 mg/dL. Comorbidities included diabetes mellitus in 124 patients (51%) and a history of current or past smoking in 122 patients (50%). Histories of ischemic heart disease, symptomatic stroke, and peripheral artery disease (PAD) were present in 50 (20%), 23 (9%), and 44 (18%) patients, respectively. VE and eA were measured during dialysis using a cuff applied to the non-access arm. Outcomes were defined as all-cause mortality and MACE (non-fatal ischemic heart disease, non-fatal symptomatic stroke, PAD requiring intervention, and cardiovascular death). During the 3-year observation period, there were 47 deaths, 20 cases of non-fatal ischemic heart disease, 6 cases of non-fatal symptomatic stroke, and 6 cases of PAD. Given that VE increases as vascular wall distensibility decreases, patients were categorized into quartiles (Groups 1 to 4) based on VE levels. Using the Kaplan-Meier method to analyze the composite endpoint (all-cause mortality plus MACE), all-cause mortality, and MACE alone, the lowest VE group showed significantly lower rates for both the composite endpoint (log-rank p=0.0124) and all-cause mortality (p=0.0271) compared to the other groups. Although eA was similarly investigated, no significant differences were observed in the composite endpoint, all-cause mortality, or MACE.
Conclusion:Higher VE values of the brachial artery in the non-shunt arm were associated with a favorable prognosis. These findings suggest that maintaining the elasticity of the brachial artery may lead to improved outcomes in patients undergoing hemodialysis.