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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Arterial stiffness and incident chronic kidney disease: a large population-based cohort study
Angela Beros1, John Sluyter1, Alun Hughes2
1School of Population Health, University of Auckland, Auckland, New Zealand.
Insights
Increased arterial stiffness, measured by pulse wave velocity and pulse pressure, significantly elevates the risk of developing chronic kidney disease (CKD). These arterial stiffness measures can help identify individuals at higher risk for future CKD.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Epidemiology
Background:
- Mixed evidence exists regarding the association between arterial stiffness and incident chronic kidney disease (CKD) in large population studies.
- This study investigates the relationship between oscillometrically assessed arterial stiffness and the incidence of CKD.
Purpose of the Study:
- To determine if arterial stiffness, assessed using various measures, is associated with the development of new-onset chronic kidney disease (CKD).
- To evaluate the predictive value of arterial stiffness parameters for incident CKD in a large population cohort.
Main Methods:
- Utilized data from 4838 participants in the Vitamin D Assessment (ViDA) Study without pre-existing CKD.
- Assessed arterial stiffness via aortic pulse wave velocity, estimated carotid-femoral pulse wave velocity, and aortic pulse pressure.
- Incident CKD was identified through national hospital discharge register linkage, with analysis using Cox proportional hazards regression.
Main Results:
- Over a mean follow-up of 10.5 years, 376 participants developed incident CKD.
- Adjusted analyses revealed significant associations: higher aortic pulse wave velocity (HR 1.69), estimated carotid-femoral pulse wave velocity (HR 1.84), and aortic pulse pressure (HR 1.37) per SD increase were linked to increased CKD risk.
- The highest quartile of all arterial stiffness measures showed substantially elevated risk for incident CKD compared to the lowest quartile (Ptrend < 0.001 for all).
Conclusions:
- Arterial stiffness, specifically aortic pulse wave velocity, estimated carotid-femoral pulse wave velocity, and aortic pulse pressure, is a significant predictor of incident CKD.
- These objective measures of arterial stiffness can be valuable tools in clinical practice for identifying individuals at risk of developing future kidney disease.
Background/Aims:
Evidence from large population-based cohorts as to the association of arterial stiffness and incident chronic kidney disease (CKD) is mixed. This large population-based study aimed to investigate whether arterial stiffness, assessed oscillometrically, was associated with incident CKD.
Methods:
The study population comprised 4838 participants from the Vitamin D Assessment (ViDA) Study without known CKD (mean ± SD age = 66 ± 8). Arterial stiffness was assessed from 5 April, 2011 to 6 November, 2012 by way of aortic pulse wave velocity, estimated carotid-femoral pulse wave velocity, and aortic pulse pressure. Incident CKD was determined by linkage to national hospital discharge registers. Cox proportional hazards regression was used to assess the risk of CKD in relation to chosen arterial stiffness measures over the continuum and quartiles of values.
Results:
During a mean ± SD follow-up of 10.5 ± 0.4 years, 376 participants developed incident CKD. Following adjustment for potential confounders, aortic pulse wave velocity (hazard ratio (HR) per SD increase 1.69, 95% CI 1.45-1.97), estimated carotid-femoral pulse wave velocity (HR per SD increase 1.84, 95% CI 1.54-2.19), and aortic pulse pressure (HR per SD increase 1.37, 95% CI 1.22-1.53) were associated with the incidence of CKD. The risk of incident CKD was, compared to the first quartile, higher in the fourth quartile of aortic pulse wave velocity (HR 4.72, 95% CI 2.69-8.27; Ptrend < 0.001), estimated carotid-femoral pulse wave velocity (HR 4.28, 95% CI 2.45-7.50; Ptrend < 0.001) and aortic pulse pressure (HR 2.71, 95% CI 1.88-3.91; Ptrend < 0.001).
Conclusions:
Arterial stiffness, as measured by aortic pulse wave velocity, estimated carotid-femoral pulse wave velocity, and aortic pulse pressure may be utilised in clinical practice to help identify people at risk of future CKD.
Trial Registration:
www.anzctr.org.au identifier:ACTRN12611000402943.
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