Mortality risk in hemodialysis patients with increased arterial stiffness is reduced by attainment of classical clinical performance measures

Abstract

Background: We determined whether attainment of classical clinical performance measures for hemodialysis care improves survival in hemodialysis patients with increased arterial stiffness.

Methods: We performed a prospective cohort study of 538 hemodialysis patients with a median follow-up of 19 months (interquartile range 8-30). Arterial stiffness was measured using applanation tonometry. Clinical performance measure targets were hemoglobin value >or=110 g/l, serum albumin value >or=37 g/l and measured single-pool Kt/V urea value >or=1.2.

Results: During follow-up, 217 patients (40%) died. In non-survivors, arterial stiffness of large arteries (S1) was significantly higher compared with survivors (p = 0.0002). An analysis of hemodialysis patients who were alive 18 months after inclusion into the study showed that survival was significantly longer in those patients that met >or=2 clinical performance measure targets compared with patients that met <or=1 target (chi(2) 4.13; p = 0.04). Better attainment of classical clinical performance measures showed a 54% mortality risk reduction.

Conclusion: S1 predicted mortality in hemodialysis patients. However, better attainment of classical clinical performance measures significantly improved long-term outcome in hemodialysis patients despite their pronounced increase in arterial stiffness.