title: Markers of arterial stiffness are risk factors for progression to end-stage renal disease among patients with chronic kidney disease stages 4 and 5.
abstract: BACKGROUND
  Factors associated with chronic kidney disease (CKD) contribute to an increased risk of cardiovascular disease and death. The impact of vascular disease on CKD progression is, however, less well studied.
  
  
  METHODS
  We examined the effect of markers of vascular disease on the risk of progression to end-stage renal disease (ESRD) in 35 patients with CKD stages 4-5. Superficial femoral artery calcification was assessed by CT scan. Augmentation index (AI) and pulse wave velocity (PWV) were measured by applanation tonometry.
  
  
  RESULTS
  After 12.4 (5.5-28.4) months, 22/35 patients (63%) had commenced dialysis. Cox regression analysis identified baseline estimated glomerular filtration rate (hazard ratio, HR, 0.54; 95% CI 0.41-0.70; p < 0.0001), urinary protein (HR 1.84; 95% CI 1.32-2.58; p = 0.0005), PWV (HR 1.30; 95% CI 1.07-1.60; p = 0.01), AI (HR 1.08; 95% CI 1.04-1.14; p = 0.0001) and pack years of smoking (HR 1.01; 95% CI 1.00-1.03; p = 0.02) as independent risk factors for time to ESRD (-2 log likelihood = 86.7; chi(2) = 30.9; p < 0.0001). Repeat analysis using AI as a categorical variable revealed an HR of 17.5 (95% CI 4.43-68.9; p < 0.0001) for time to ESRD in those with AI above versus below the median.
  
  
  CONCLUSIONS
  We have identified two markers of arterial stiffness as independent risk factors for progression to ESRD suggesting that vascular disease may contribute to CKD progression.
authors.affiliation: Department of Renal Medicine, Derby Hospitals NHS Foundation Trust, Derby, UK.
authors.forename: Maarten W
authors.initials: MW
authors.lastname: Taal
authors.forename: Mhairi K
authors.initials: MK
authors.lastname: Sigrist
authors.forename: Apostolos
authors.initials: A
authors.lastname: Fakis
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Fluck
authors.forename: Christopher W
authors.initials: CW
authors.lastname: McIntyre
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000628:therapy; D000368:Aged; D015415:Biomarkers / Q000032:analysis*; D016001:Confidence Intervals; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000628:therapy; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011336:Probability; D016016:Proportional Hazards Models; D011673:Pulsatile Flow; D012079:Renal Circulation; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012720:Severity of Illness Index; D014655:Vascular Resistance
chemical_list: D015415:Biomarkers