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Abstract: PO0863

The Combination of Arterial Stiffness and Peripheral Vascular Disease Aggravates Survival Among Hemodialysis Patient Using Competing Risk Analysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Pathumarak, Adisorn, Mahidol University Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
  • Thammavaranucupt, Kanin, Mahidol University Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
  • Kitiyakara, Chagriya, Mahidol University Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
  • Nongnuch, Arkom, Mahidol University Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
Background

The survival in end state renal disease (ESRD) patient is unacceptable high. The Skin autofluorescence (SAF) for advance glycation end products (AGEs), peripheral vascular disease (PVD) (ankle-brachial index, ABI ≤0.9) and arterial stiffness (cardio ankle vascular index ,CAVI>9) were reports as predictors of mortality. However, kidney transplantation (KT) competes the mortality outcome. We aim to explore these markers for precisely prediction of mortality using competing risk method.

Methods

Retrospective chart review in chronic hemodialysis patients was done in 3 hemodialysis centers in North Bangkok during November 2015 and March 2016. Arterial stiffness, SAF, IMAR and PVD were collected as a clinical predictor. Cumulative incidence of mortality was used as was a primary outcome. Logistic regression with competing risk model was used to analyze the factor affecting mortality.

Results

A Total of 176 patients were eligible and classified into 4 groups according to PVD and stiffness status. During follow up 44.5±14.8 months, the overall mortality rate was 27% which is 13.2, 28.6, 31.5 and 61.9% in no PVD and stiffness, exclusively PVD, exclusively stiffness, and combine group respectively. The PVD (HR 2.93, CI 1.2 to 7.14, P=0.018) and stiffness (HR 2.57, CI 1.16 to 5.73, P=0.021) were independent predictors of mortality. In competing risk method, the combination of PVD and stiffness associate with highest mortality (P=0.0002139), while the patients who no PVD and stiffness had the highest rate for KT (P=0.0050275).

Conclusion

The PVD and stiffness were an independent risk of mortality among hemodialysis patients. The combination of PVD and stiffness may stratify risk of mortality in hemodialysis patient using competing risk method.

Cumulative incidence of death and KT according to PVD and stiffness status in competing risk method