Combining Pulse Wave Velocity With Galectin-3 to Predict Mortality and Cerebrovascular and Cardiovascular Events in Hemodialysis Patients

Background: Cerebrovascular and cardiovascular diseases contribute substantially to the mortality of end-stage renal disease (ESRD) patients. We sought to combine pulse wave velocity (PWV) with galectin-3 to predict the mortality and cerebrovascular and cardiovascular events in hemodialysis patients. Methods and Results: ESRD patients who underwent stable hemodialysis were screened for inclusion. Patients with pre-existing cardiovascular and cerebrovascular diseases were excluded. The primary endpoint was a composite of all-cause mortality and major adverse cerebrovascular and cardiovascular events. Receiver operating characteristic curve analysis was used to determine the optimal cutoffs to dichotomize PWV and galectin-3. The study population was then stratified into four groups based on these cutoffs. Both univariable and multivariable Cox regression analyses were performed to estimate the hazard ratio (HR) and 95% confidence interval (CI) for clinical factors. Model performance was compared among models with or without PWV and galectin-3. A total of 284 patients were enrolled. During a median follow-up of 31 months, 57 patients (20.1%) reached the primary endpoint. The optimal cutoffs for PWV and galectin-3 were 7.9 m/s and 30.5 ng/mL. In the multivariable regression analysis, the high PWV - high galectin-3 group was associated with a three-fold increased risk of all-cause mortality and major adverse cerebrovascular and cardiovascular events (HR = 3.19, 95% CI: 1.05-9.66, p = 0.04) compared to the low PWV - low galectin-3 group. The combination of PWV and galectin-3 was associated with improved model discrimination, calibration, and reclassification. Conclusions: The combination of PWV and galectin-3 can be used to predict mortality and cerebral and cardiovascular complications in hemodialysis patients.