title: Association of increased arterial wave reflections with decline in renal function in chronic kidney disease stages 3 and 4.
abstract: BACKGROUND
  Increased arterial wave reflections predict cardiovascular events in dialysis patients. Their impact on the progression of renal disease has not been determined.
  
  
  METHODS
  We prospectively quantified wave reflections as pressure augmentation (AP) and augmentation index (AIx) using radial applanation tonometry and a transfer function, in 111 patients (mean age 53.6 years; 71 men, 31 diabetics) with chronic kidney disease not requiring dialysis. Primary endpoint was a composite of doubling of serum creatinine, need for dialysis, and transplantation. Secondary endpoint was a combination of renal and cardiovascular events.
  
  
  RESULTS
  After a mean follow-up of 41.3 months, 37 and 46 patients reached the primary and the secondary endpoint. AIx and AP proved statistically significant predictors of the renal endpoint (P < 0.05 for all), with a 2.5- and 3-fold increased risk for patients in the highest vs. the lowest tertile, respectively. After adjustment for mean blood pressure (MBP), age, gender, diabetes, serum albumin, hemoglobin, urine albumin/creatinine ratio, and renal function at baseline, AIx (hazard ratio 1.474/10% increase in AIx, P = 0.04) as well as AP (hazard ratio 1.559/10 mm Hg increase in AP, P = 0.04) remained significant predictors of the renal endpoint. In addition, AIx and AP were significant (P < 0.05) predictors of the combined cardiorenal endpoint in univariate analysis and multivariable models.
  
  
  CONCLUSIONS
  Increased arterial wave reflections are independent predictors of renal as well as cardiorenal events in patients with chronic kidney disease.
authors: Cardiology Department, Klinikum Wels-Grieskirchen, Wels, Austria. thomas.weber3@liwest.at
authors: Thomas
authors: T
authors: Weber
authors: Marcus
authors: M
authors: Ammer
authors: Duygu
authors: D
authors: Gündüz
authors: Paul
authors: P
authors: Bruckenberger
authors: Bernd
authors: B
authors: Eber
authors: Manfred
authors: M
authors: Wallner
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology; D002908:Chronic Disease; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000503:physiopathology*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011673:Pulsatile Flow / Q000502:physiology*; D012720:Severity of Illness Index