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Creatinine clearance, pulse wave velocity, carotid compliance and essential hypertension
J J Mourad1, B Pannier, J Blacher
1Department of Internal Medícine, Hôpital Broussais, Paris, France.
Insights
Arterial stiffness is linked to reduced kidney function in individuals with mild-to-moderate renal insufficiency. This association between arterial stiffness and creatinine clearance is independent of common cardiovascular risk factors.
Area of Science:
- Nephrology
- Cardiology
- Vascular Biology
Background:
- End-stage renal disease is characterized by increased arterial stiffness, independent of traditional cardiovascular risk factors.
- The relationship between arterial stiffness and kidney function in individuals with plasma creatinine levels ≤130 µmol/L remains unclear.
- This study investigates the association between arterial stiffness and renal function in a cohort with normal to elevated blood pressure and mild-to-moderate renal insufficiency.
Purpose of the Study:
- To determine if arterial stiffness is statistically associated with kidney function in subjects with plasma creatinine ≤130 µmol/L.
- To explore the relationship between arterial stiffness and creatinine clearance, independent of blood pressure and cardiovascular risk factors.
- To examine age-related differences in the association between arterial stiffness and renal function.
Main Methods:
- 1290 subjects with plasma creatinine ≤130 µmol/L were divided into tertiles based on calculated creatinine clearance.
- Aortic pulse wave velocity (PWV) was measured as an indicator of arterial stiffness.
- In a subset of 112 hypertensive subjects, common carotid and radial artery structure and function were assessed using high-resolution echo-Doppler techniques.
Main Results:
- A significant negative association was found between PWV and creatinine clearance in the lowest creatinine clearance tertile, independent of blood pressure and risk factors.
- This association was more pronounced in subjects aged 55 years or younger.
- Carotid artery compliance positively correlated with creatinine clearance in hypertensive subjects, particularly in those under 55, where it accounted for 20% of the variance.
Conclusions:
- Increased stiffness of central arteries is statistically linked to reduced creatinine clearance in individuals with mild-to-moderate renal insufficiency.
- Kidney function may influence the stiffness of both small and large arteries, independent of age, blood pressure, and standard risk factors.
- These findings highlight a potential interaction between renal insufficiency and vascular health beyond established cardiovascular risk profiles.
Background:
The vascular hallmark of subjects with end-stage renal disease is increased arterial stiffness independent of blood pressure, wall stress, and cardiovascular risk factors such as hypertension, plasma glucose and cholesterol, obesity, and tobacco consumption. Whether arterial stiffness and kidney function are statistically associated in subjects with plasma creatinine < or =130 micromol/L has not yet been determined. Material. In 1290 subjects with normal or elevated blood pressure values and plasma creatinine < or =130 micromol/L, subjects were divided into three tertiles according to the calculated creatinine clearance. Blood pressure, aortic pulse wave velocity (PWV), and standard cardiovascular risk factors were determined in parallel. In 112 of the hypertensive subjects, common carotid and radial artery structure and function (high-resolution echo-Doppler techniques) also were measured.
Results:
From the 1290 subjects, only the low-tertile group presented a significant negative association between PWV and creatinine clearance independently of blood pressure and standard risk factors. This association was stronger in subjects < or =55 years of age. In the 112 hypertensive subjects, carotid compliance was positively correlated to creatinine clearance even after an adjustment for age, gender, and blood pressure. At less than 55 years of age, creatinine clearance represented 20% of the variance of carotid compliance. Such findings were not observed for radial artery compliance.
Conclusion:
Increased stiffness of central arteries is statistically associated with reduced creatinine clearance in subjects with mild-to-moderate renal insufficiency, indicating that kidney alterations may interact not only with small but also large arteries, and this is independent of age, blood pressure, and standard risk factors.