Evaluation of carotid intima-media thickness and ultrafast pulse wave velocity for cardiovascular events and all-cause mortality in hemodialysis patients: impact of diabetes.

Arterial remodeling is common in end-stage renal disease (ESRD). This prospective cohort study explored the potential prognostic value of carotid intima-media thickness (CIMT) and ultrafast pulse wave velocity (ufPWV) - including pulse wave velocity at the beginning (PWV-BS) and end of systole (PWV-ES) for cardiovascular (CV) events and all-cause mortality in 115 maintenance hemodialysis (MHD) patients followed for 39 months. Compared with non-ESRD controls, MHD patients exhibited significantly higher CIMT (1.60 vs 0.80 mm, p = 0.004), while ufPWV parameters appeared comparable. During follow-up, 21 CV events and 17 deaths were recorded. In univariable analysis, CIMT was associated with CV events and positively correlated with diabetes (r = 0.271, p = 0.003). However, after adjusting for diabetes, this association was no longer statistically significant (HR 1.350, 95% CI 0.865-2.106, p = 0.186). Neither PWV-BS nor PWV-ES was associated with outcomes in the overall cohort. Preliminary subgroup analysis of patients with diabetes (n = 36, 15 CV events) observed an inverse association between left PWV-ES and CV events. In conclusion, CIMT was no longer significantly associated with CV events after adjustment for diabetes in the limited model, whereas local ufPWV parameters were not significantly associated with CV events or all-cause mortality in the analyses performed within the overall MHD population. Given the issue of multiple comparisons and small sample size, the isolated finding between left PWV-ES and CV events in the diabetic subgroup must be treated strictly as hypothesis-generating, requiring independent validation in a larger cohort.