Supplementary Material for: High Pulse-Wave Velocity Defines a Very High Cardiovascular Risk Cohort of Dialysis Patients under Age 60

<b><i>Background:</i></b> Patients with end-stage renal disease (ESRD) are at a high risk of cardiovascular mortality (CVM). In patients with ESRD, arterial stiffness increases at an earlier age when compared to the general population and this contributes to the overall risk of cardiovascular mortality. The main objective of this study was to clarify the interplay between age and cardiovascular alterations in ESRD. <b><i>Methods:</i></b> Prospective, observational cohort study initiated in April 1987 until the end of 1998 with events recorded until the end of the year 2000 at the F.H. Manhes Hospital Center, Fleury-Mérogis (in the Paris/Ile de France area). <b><i>Results:</i></b> The study population consisted of 278 ESRD patients undergoing dialysis therapy. The mean ± SD age was 53 ± 16 years. The mean pulse-wave velocity (PWV) was ∼11 m/s, with ∼37% of patients having a PWV &gt;12 m/s. During the follow-up period, 91 patients died from CV causes. PWV &gt;12 m/s was associated with CVM in the unadjusted model but lost its prognostic value in patients &gt;60 years (p for interaction = 0.008). In patients ≤60 years, PWV was found to be a strong and independent predictor of CVM with hazards ratio (95% CI) of 14.382 (7.120-29.047), p &lt; 0.001, and it improved the prognostic reclassification of a model containing well-established prognostic variables. According to multivariable regression analysis, aortic PWV was strongly associated with age (R² = 0.37, p &lt; 0.001). <b><i>Conclusion:</i></b> A PWV &gt;12 m/s provides important prognostic information in ESRD patients under 60 years of age, whereas in older patients, its prognostic relevance is lost. These findings are of critical relevance for early intervention guidance and trial end-point/treatment effect interpretation.

<b><i>背景：</i></b> 终末期肾病（end-stage renal disease, ESRD）患者具有极高的心血管死亡率（cardiovascular mortality, CVM）风险。与普通人群相比，终末期肾病患者的动脉僵硬度会在更早的年龄阶段出现升高，这会进一步提升患者的心血管死亡总风险。本研究的核心目的在于阐明终末期肾病患者年龄与心血管病变之间的相互关联。<b><i>方法：</i></b> 本研究为一项前瞻性观察队列研究，于1987年4月启动，随访至1998年底，研究事件的收集截止至2000年底，开展地点位于法国巴黎法兰西岛地区弗勒里-梅罗吉市的F.H. Manhes医疗中心。<b><i>结果：</i></b> 本研究共纳入278名接受透析治疗的终末期肾病患者，受试者的平均年龄±标准差为53±16岁。平均脉搏波速度（pulse-wave velocity, PWV）约为11 m/s，其中约37%的患者PWV＞12 m/s。随访期间，共有91名患者因心血管原因死亡。在未校正模型中，PWV＞12 m/s与心血管死亡率显著相关，但在年龄＞60岁的患者中，该指标的预后预测价值消失（交互项p=0.008）。在年龄≤60岁的患者中，PWV是心血管死亡率的强独立预测因子，其风险比（95%置信区间）为14.382（7.120~29.047），p＜0.001；同时该指标可提升包含已确立预后变量的模型的预后重新分类能力。多变量回归分析结果显示，主动脉脉搏波速度与年龄呈强相关性（R²=0.37，p＜0.001）。<b><i>结论：</i></b> PWV＞12 m/s可为60岁以下的终末期肾病患者提供重要的预后评估信息，而在老年患者中，该指标的预后指导价值则不复存在。上述研究结果对于早期干预策略的制定以及临床试验终点、治疗效果的解读均具有至关重要的指导意义。