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. 2024 Jun 27;17(7):sfae172.
doi: 10.1093/ckj/sfae172. eCollection 2024 Jul.

Measures of wave intensity as a non-invasive surrogate for cardiac function predicts mortality in haemodialysis patients

Christopher C Mayer  1   2 , Pantelis A Sarafidis  3 , Julia Matschkal  4 , Marieta Theodorakopoulou  3 , Georg Lorenz  4 , Artemios Karagiannidis  3 , Susanne Angermann  4 , Fotini Iatridi  3 , Matthias C Braunisch  4 , Antonios Karpetas  5 , Marcus Baumann  4 , Eva Pella  3 , Uwe Heemann  4 , Siegfried Wassertheurer  1   2 , Christoph Schmaderer  4
Affiliations

Measures of wave intensity as a non-invasive surrogate for cardiac function predicts mortality in haemodialysis patients

Christopher C Mayer et al. Clin Kidney J. .

Abstract

Background: Risk prediction in haemodialysis (HD) patients is challenging due to the impact of the dialysis regime on the patient's volume status and the complex interplay with cardiac function, comorbidities and hypertension. Cardiac function as a key predictor of cardiovascular (CV) mortality in HD 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: A total of 558 (373 male/185 female) HD 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:D ratio (SDR)]. All-cause and CV mortality served as endpoints and multivariate proportional hazards models were used for risk prediction. Intradialytic changes were analysed in tertiles according to ultrafiltration volume. During a follow-up of 37.8 months, 193 patients died (92 due to CV reasons).

Results: The SDR was significantly associated with all-cause {univariate hazard ratio [HR] 1.36 [95% confidence interval (CI) 1.20-1.54], P < .001} and CV [univariate HR 1.41 (95% CI 1.20-1.67), P < .001] mortality. The associations remained significant in multivariate analysis accounting for possible confounders. Changes in the 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.

Keywords: ESKD; blood pressure; cardiac function; haemodialysis; wave intensity analysis.

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Conflict of interest statement

S.W. and C.C.M. are the inventors (not holders) of a patent that is partly used in the ARCSolver algorithm in the Mobil-O-Graph 24-hour PWA. The remaining authors declare no conflicts of interest.

Figures

Graphical Abstract
Graphical Abstract
Figure 1:
Figure 1:
Flowchart of included patients.
Figure 2:
Figure 2:
Association of normalized SBP, PP and SDR with mortality from univariate proportional Cox regression analysis. Univariate association of normalized SBP, PP and SDR (i.e. HR per SD) with (A–C) all-cause and (D–F) CV mortality for the AF or HF group (A, C), the No AF or HF group (B, E) and the whole study population (C, F). zSBP: z-score of SBP; zPP: z-score of PP; zSDR: z-score of SDR from wave intensity analysis.
Figure 3:
Figure 3:
Changes from pre-/early- to post-dialytic SDR according to ultrafiltration tertiles. ***P < .001 from non-parametric, pairwise comparison with Holm–Bonferroni correction for multiple testing.
See this image and copyright information in PMC

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