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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Prediction of CKD Progression and Cardiovascular Events Using Albuminuria and Pulse Wave Velocity
Rasmus Kirkeskov Carlsen1,2, Dinah Sherzad Khatir1, Danny Jensen1
1Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.
Insights
Urine albumin-creatinine ratio predicts chronic kidney disease (CKD) progression and adverse cardiovascular events. Arterial stiffness, measured by pulse wave velocity (PWV), did not show predictive value in this CKD patient cohort.
Area of Science:
- Nephrology
- Cardiology
- Biomarker Discovery
Background:
- Chronic kidney disease (CKD) significantly increases risks for cardiovascular disease (CVD) and mortality.
- Established biomarkers like albuminuria are crucial, yet additional predictors for CKD progression and CVD are needed.
- Arterial stiffness, assessed via carotid-femoral pulse wave velocity (PWV), is a measurable parameter linked to CVD and mortality.
Purpose of the Study:
- To evaluate the predictive capabilities of urine albumin-creatinine (UAC) ratio and PWV for CKD progression, cardiovascular events, and mortality.
- To identify reliable biomarkers for risk stratification in patients with CKD stages 3-5.
Main Methods:
- A cohort of 181 CKD stage 3-5 patients had baseline measurements of UAC and PWV.
- CKD progression was defined by a 50% eGFR decline, dialysis initiation, or renal transplantation.
- A composite endpoint included CKD progression, myocardial infarction, stroke, or death, analyzed using adjusted Cox regression.
Main Results:
- Urine albumin-creatinine ratio (UAC) significantly predicted both CKD progression (HR 1.5) and the composite endpoint (HR 1.4) in adjusted analyses.
- Carotid-femoral pulse wave velocity (PWV) was not associated with CKD progression (HR 0.99) or the composite endpoint (HR 1.03).
- The study included 181 patients with a median follow-up of 4 years, observing 44 CKD progressions and 89 composite events.
Conclusions:
- Urine albumin-creatinine ratio serves as a valuable predictor of CKD progression and adverse outcomes in an aging CKD population.
- Pulse wave velocity (PWV) did not demonstrate predictive utility for CKD progression or the composite endpoint in this cohort.
- These findings highlight the importance of UAC as a prognostic biomarker in managing CKD patients.
Introduction:
Chronic kidney disease (CKD) is associated with cardiovascular disease (CVD) and death. Albuminuria is an established risk factor, but additional biomarkers predicting CKD progression or CVD are needed. Arterial stiffness is an easily measurable parameter that has been associated with CVD and mortality. We evaluated the ability of carotid-femoral pulse wave velocity (PWV) and urine albumin-creatinine (UAC) ratio to predict CKD progression, cardiovascular events, and mortality in a cohort of CKD patients.
Methods:
In CKD stage 3-5 patients, PWV and UAC were measured at baseline. CKD progression was defined as 50% decline in estimated glomerular filtration rate (eGFR), initiation of dialysis, or renal transplantation. A composite endpoint was defined as CKD progression, myocardial infarction, stroke, or death. Endpoints were analyzed using Cox regression analysis adjusted for possible confounders.
Results:
We included 181 patients (median age 69 [interquartile range 60-75] years, 67% males) with a mean eGFR of 37 ± 12 mL/min/1.73 m2 and UAC 52 (5-472) mg/g. Mean PWV was 10.6 m/s. Median follow-up until first event was 4 (3-6) years with 44 and 89 patients reaching a CKD progression or composite endpoint, respectively. UAC (g/g) significantly predicted both CKD progression (HR 1.5 [1.2; 1.8]) and composite endpoints (HR 1.4 [1.1; 1.7]) in adjusted Cox regression. In contrast, PWV (m/s) was not associated with neither CKD progression (HR 0.99 [0.84; 1.18]) nor the composite endpoint (HR 1.03 [0.92; 1.15]).
Conclusion:
In an aging CKD population, UAC predicted both CKD progression and a composite endpoint of CKD progression, cardiovascular events, or death, while PWV did not.
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