Aortic Calcification and Pulse Wave Velocity Remain Associated after Adjustment for Kidney Function and Covariates

Aortic wall calcification increases arterial stiffness which is often assessed by carotid-femoral pulse wave velocity (cfPWV). However, the impact of kidney function upon the association between calcification of the aortic wall and cfPWV remains unknown.

To examine the association between aortic calcification and cfPWV, we prospectively recruited chronic kidney disease (CKD) patients (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m²) and patients with normal renal function, planned for invasive coronary angiography. Participants underwent a non-contrast computed tomography scan of the entire aorta with subsequent Agatston scoring of the aortic wall in addition to a standardized cfPWV measurement and biochemical markers.

A total of 144 patients (67.1 ± 10.3 years, 24% female), of whom 110 had CKD (26 stage 3a, 33 stage 3b, 24 stage 4, and 27 stage 5), were included. Agatston score was associated with cfPWV in a univariate regression analysis (p < 0.001). So were age (p < 0.001) and diabetes (p = 0.001), but not gender, smoking status, eGFR, office systolic blood pressure, calcium-phosphate product, C-reactive protein nor vasodilator treatment. Multiple regression analysis including all these factors did not significantly change these associations and relative weight analysis revealed Agatston score to account for 30% of the variation in cfPWV in the model (total r ² = 0.31).

In a cohort representing the entire spectrum of kidney function, aortic Agatston score, as well as age and diabetes, were associated with cfPWV after adjustment for other risk factors including eGFR. However, most of the variation in cfPWV remains unexplained by these factors.