Stepwise increase in arterial stiffness corresponding with the stages of chronic kidney disease.
BACKGROUND
Patients with end-stage renal disease on maintenance dialysis therapy have a high prevalence of cardiovascular risk factors and cardiovascular disease (CVD). A similar finding is noted in patients with chronic kidney disease (CKD). The important contributors are premature and accelerated atherosclerosis and vascular calcification. We assessed the severity of arterial stiffness in 102 patients with CKD by using pulse wave velocity (PWV) and sought to identify associated risk factors.


METHODS
PWV was measured by calculating the distance traveled by the flow wave and divided by the time delay. Correlations between PWV and traditional cardiovascular risk factors, estimated glomerular filtration rate (GFR) per 1.73 m2 , blood pressure (BP), and pulse pressure (PP) were analyzed.


RESULTS
PWV values in patients with CKD stages 1 to 2 and the age-matched control group were similar. There was a significant trend for a stepwise increase in PWV corresponding to advance in CKD stage (P < 0.0001). Univariate linear regression analysis showed that age, prior CVD, diabetes, hypertension, any high risk, estimated GFR per 1.73 m2 , systolic BP, and PP correlated with PWV. In the multivariate model, decreased estimated GFR per 1.73 m2 and increased systolic BP were independently associated with increased PWV in patients with CKD (model R 2 = 0.539; P < 0.0001).


CONCLUSIONS
This is the first study to show a greater PWV in patients with more advanced CKD from stages 1 to 5. Estimated GFR per 1.73 m2 and systolic BP were the major clinical determinants of arterial stiffness in patients with CKD independent of conventional risk factors for CVD.
Wang
Ming-Cheng
MC
Department of Internal Medicine, Division of Nephrology, National Cheng Kung University Medical Center, Tainan, Taiwan, ROC.
Tsai
Wei-Chuan
WC
Chen
Ju-Yi
JY
Huang
Jeng-Jong
JJ
D000328:Adult; D000368:Aged; D001011:Aorta / Q000503:physiopathology; D001161:Arteriosclerosis / Q000150:complications / Q000503:physiopathology; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000401:mortality; D015897:Comorbidity; D003327:Coronary Disease / Q000150:complications / Q000503:physiopathology; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D018056:Hemorheology; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000503:physiopathology; D006973:Hypertension / Q000150:complications / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000503:physiopathology; D006435:Renal Dialysis; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D014655:Vascular Resistance