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Central blood pressures in early chronic kidney disease: an analysis of CARTaGENE
Rémi Goupil1, Dominique Dupuis1, Mohsen Agharazii2
1Department of Nephrology, Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, QC, Canada.
Insights
Early chronic kidney disease (CKD) and albuminuria do not independently increase central blood pressure (BP) or vascular stiffness. This study found no significant association between mild-to-moderate CKD and adverse central hemodynamic parameters in a large population cohort.
Area of Science:
- Cardiology
- Nephrology
- Public Health
Background:
- Vascular stiffness and advanced chronic kidney disease (CKD) are linked to elevated central blood pressure (BP) and increased cardiovascular risks.
- The association between mild-to-moderate CKD and central BP, independent of comorbidities, remains unclear.
Purpose of the Study:
- To investigate whether Stage 3 CKD is independently associated with altered central hemodynamic parameters.
- To compare the central hemodynamic profile of Stage 3 CKD patients with individuals with estimated glomerular filtration rate (eGFR) >60 mL/min/1.73 m².
Main Methods:
- Utilized data from the CARTaGENE population cohort, including 515 Stage 3 CKD patients and controls with eGFR >60 mL/min/1.73 m².
- Employed propensity score matching and multivariate regression analyses to evaluate central systolic BP, central pulse pressure (PP), and other hemodynamic indices.
- Assessed albuminuria levels in a subset of participants.
Main Results:
- Initially, Stage 3 CKD patients showed higher peripheral systolic BP and central PP compared to controls.
- After propensity score matching, central BP parameters were similar between Stage 3 CKD patients and controls.
- Multivariate analysis indicated that higher central hemodynamic readings in Stage 3 CKD disappeared after adjusting for comorbidities.
- Albuminuria was not independently associated with higher central hemodynamic indices in the studied subset.
Conclusions:
- Early-stage CKD (Stage 3) and albuminuria are not independently linked to detrimental central hemodynamic parameters in a general population cohort.
- These findings suggest that comorbidities, rather than early CKD itself, may drive adverse cardiovascular changes.
Background:
Vascular stiffness and advanced chronic kidney disease (CKD) are strong determinants of higher central blood pressure (BP) and are associated with high cardiovascular morbidity and mortality. Whether mild-to-moderate CKD is associated with higher central BP independently of other comorbid conditions remains uncertain.
Methods:
We evaluated the central hemodynamic profile [central systolic BP, central pulse pressure (PP), augmentation index, PP amplification, augmented pressure] of Stage 3 CKD patients and compared it with participants with estimated glomerular filtration rate (eGFR) >60 mL/min/1.73 m 2 in the CARTaGENE populational cohort through propensity score matching and multivariate regression analyses.
Results:
Of the 20 004 participants, 13 114 had valid pulse wave analysis and eGFRs >30 mL/min/1.73 m 2 , of which 515 had Stage 3 CKD. These 515 patients had significantly higher peripheral systolic BP (127 ± 16 versus 125 ± 15 mmHg, P = 0.01) and central PP (43.0 ± 11.4 versus 39.7 ± 10.0 mmHg, P <0.001) than the control group (eGFR >60 mL/min/1.73 m 2 ). Propensity score matching allowed the creation of 500 pairs with similar clinical characteristics. In this matched cohort, central BPs were similar in Stage 3 CKD patients compared with controls (central PP 42.9 ± 11.3 versus 43.7 ± 11.3 mmHg, P = 0.3). Multivariate analysis using data from all patients also found that the higher central hemodynamic readings found in Stage 3 CKD patients disappeared after adjusting for comorbid conditions. In a subset of 609 participants in whom albuminuria levels were measured, urine albumin excretion was not independently associated with higher central hemodynamic indices.
Conclusion:
In this large cohort from the general population, early CKD and albuminuria was not independently associated with detrimental central hemodynamic parameters.