Aortic pulse wave velocity (PWV) is a strong independent predictor of overall and
cardiovascular mortality in patients with end-stage renal disease (ESRD). Nevertheless,
because age, blood pressure, heart rate, and gender are strong determinants of both
arterial stiffness and mortality, the individual relevance of PWV measurements remains
A cohort of 242 patients with ESRD undergoing hemodialysis was studied for a mean
(+/- SD) duration of 78 +/- 46 months. At entry, together with standard clinical and
biochemical analyses, PWV was measured using Doppler ultrasonography. On the basis
of a nomogram established on 469 nonuremic subjects, a theoretical value of PWV was
determined in ESRD patients according to their age, blood pressure, gender, and heart
period. The PWV index (measured PWV - theoretical PWV) was then calculated for each
individual ESRD patient.
Based on Cox analysis, the PWV index, but neither pulse pressure nor cardiac mass,
was a strong and independent predictor of both cardiovascular and overall mortality,
together with age and time on dialysis before inclusion. Patients with positive (versus
negative) PWV index had a twofold adjusted risk of mortality during the follow-up.
Per each 1 meter/second PWV index increment, we observed a 34% (crude) and a 14% (adjusted)
increase in both cardiovascular and overall mortality (P < 0.02 for all).
In ESRD patients, the calculation of a PWV index provides information about cardiovascular
and overall mortality risk with high predictive power, showing that PWV measurements
provide discriminatory prognostic power over and above conventional cardiovascular