Arterial Stiffness and Acute Kidney Injury in the Atherosclerosis Risk in Communities (ARIC) Study

Acute kidney injury (AKI) is associated with prolonged hospitalization and increased in-hospital mortality risk. However, the prediction of incident AKI is inaccurate, and additional predictors of AKI are strongly needed. Arterial stiffness, as measured using carotid-femoral pulse wave velocity (cfPWV), is associated with kidney function decline and may serve as a plausible predictor of AKI. We hypothesized a higher cfPWV at baseline would be independently associated with AKI risk in community-dwelling older adults who participated in the Atherosclerosis Risk in Communities study.

Observational cohort study.

Community-dwelling older adults from the Atherosclerosis Risk in Communities study.

The primary predictor was cfPWV and secondary predictors were heart-femoral pulse wave velocity (PWV), heart-carotid PWV, heart-ankle PWV, and brachial-ankle PWV, and femoral-ankle PWV.

Time to AKI, defined by International Classification of Diseases (ICD) codes.

Cox proportional hazard models were used to examine the association between PWV measures and time to AKI. Given its J-shaped relation with AKI, PWV was modeled as a categorical variable in quartiles (Q), with Q2 serving as the reference category.

A total of 4,245 participants (44% male; 77% White; mean ± SD age 75 ± 5 years; cfPWV 11.9 ± 3.9 m/s) were included. There was a J-shaped association between cfPWV and AKI risk (Q1, hazard ratio 1.15 [95% confidence interval 0.90-1.46]; Q4, 1.38 [1.08-1.77] vs Q2 reference) after fully adjusting for demographics, cardiovascular disease risk factors, and markers for kidney function and peripheral artery disease.

Most of the participants were White; and AKI was defined based on ICD codes.

Higher arterial stiffness, measured by cfPWV, may potentially serve as a predictor of AKI risk in community-dwelling older adults.