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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Interrelationship between aortic stiffness and proteinuria in chronic kidney disease
C R Pan1, M Roos, C Schmaderer
1Department of Nephrology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
Insights
In chronic kidney disease (CKD) patients, aortic stiffness and proteinuria are generally linked. However, this association is lost in younger CKD patients with primary kidney disease, where aortic stiffness does not predict proteinuria.
Area of Science:
- Nephrology
- Cardiology
- Vascular Biology
Background:
- Aortic stiffness and proteinuria are recognized cardiovascular risk factors.
- Their association is well-established in the general population.
- The relationship in chronic kidney disease (CKD) patients requires further investigation.
Purpose of the Study:
- To investigate the association between aortic stiffness and proteinuria in patients with CKD.
- To determine if aortic stiffness predicts proteinuria in younger CKD patients with predominant sole renal disease.
Main Methods:
- Cross-sectional analysis of 144 patients with mild-to-severe CKD.
- Aortic stiffness measured by carotid-femoral pulse wave velocity (C-F PWV).
- Proteinuria assessed by urine protein-creatinine ratio (P-C ratio).
- Stepwise linear regression used for analysis.
Main Results:
- A general association between C-F PWV and P-C ratio was observed in CKD patients.
- Younger patients (<50 years) with proteinuria predominantly had glomerulonephritis.
- These younger patients showed lower C-F PWV despite similar renal function compared to those without glomerulonephritis.
- C-F PWV did not predict proteinuria in young CKD patients with sole renal disease.
Conclusions:
- A general relationship between aortic stiffness and proteinuria exists in CKD patients.
- This relationship is absent in young CKD patients where renal disease is the primary cause of proteinuria.
- Carotid-femoral pulse wave velocity is not predictive of proteinuria in this specific subgroup.
Abstract:
Aortic stiffness and proteinuria are cardiovascular risk factors that are generally associated with each other. We analysed whether this is true for patients with chronic kidney disease (CKD). We hypothesized that in CKD patients of young age and predominant sole renal disease, aortic stiffness has no predictive value for proteinuria. In a cross-sectional setting, 144 patients with severe-to-mild CKD (estimated glomerular filtration rate (eGFR) 0 to <90 ml min(-1) 1.73 m(-2)) were analysed for stiffness, as measured using carotid-femoral pulse wave velocity (C-F PWV), and proteinuria, as determined using protein-creatinine ratio from morning spot urine. In stepwise linear regression analysis, C-F PWV predicted protein-creatinine ratio and vice versa. Younger patients (<50 years) with proteinuria had predominant glomerulonephritis. These were characterized by lower C-F PWV despite similar renal function when compared with younger patients without glomerulonephritis. We conclude that in CKD patients a general relationship exists between aortic stiffness and proteinuria. It is noted that this relation is lost in young CKD patients with predominant sole renal disease. In this study, C-F PWV is not predictive for proteinuria as renal disease is the leading cause of proteinuria.
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