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Assessment of Vascular Function in Patients With Chronic Kidney Disease
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The relationship of renal function to segmental vascular stiffness, ankle-brachial index, and peripheral artery

Yueh-Hung Lin1,2, Kuo-Tzu Sung1,2, Cheng-Ting Tsai1,2

  • 1Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.

Journal of Clinical Hypertension (Greenwich, Conn.)
|May 12, 2018
PubMed

Insights

Early kidney insufficiency is linked to vascular stiffness and peripheral artery disease (PAD). Lower estimated glomerular filtration rate (eGFR) and ankle-brachial index (ABI) indicate higher PAD risk.

Area of Science:

  • Cardiovascular Medicine
  • Nephrology
  • Vascular Biology

Background:

  • Peripheral artery disease (PAD) is a common manifestation of atherosclerosis.
  • Cardiovascular risk factors often coexist with impaired renal function.
  • Vascular stiffness is an independent predictor of cardiovascular events.

Purpose of the Study:

  • To investigate the association between renal function and vascular stiffness indices, including pulse-wave velocity (PWV) and ankle-brachial index (ABI).
  • To determine if reduced estimated glomerular filtration rate (eGFR) is an independent predictor of PAD risk.

Main Methods:

  • Cross-sectional study of 2309 outpatients with at least one cardiovascular risk factor.
  • Assessment of various pulse-wave velocity (PWV) indices and ankle-brachial index (ABI) using an automatic device.
  • Multivariate regression analysis to identify independent associations between eGFR, ABI, PWV, and PAD risk.

Main Results:

  • Worse renal function (lower eGFR) was associated with higher brachial-ankle PWV, heart-carotid PWV, heart-femoral PWV (hf-PWV), and lower ABI (all P < .001).
  • Lower eGFR and ABI, and higher hf-PWV were independently associated with greater PAD risk (P < .05).
  • An eGFR cutoff of 77 mL/min/1.73m² demonstrated utility in identifying PAD (P for ΔAUROC: .009).

Conclusions:

  • Early renal insufficiency is significantly linked to region-specific vascular stiffness and PAD.
  • Reduced eGFR is an independent risk factor for PAD.
  • ABI and PWV measurements, in conjunction with eGFR, may aid in early PAD detection in at-risk populations.

Keywords:
ankle-brachial indexperipheral artery diseasepulse-wave velocityrenal insufficiencyvascular stiffness

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