title: Hemodynamic correlates of proteinuria in chronic kidney disease.
abstract: OBJECTIVE
  Brachial artery measures of BP are associated with increasing degrees of proteinuria. Whether central measures of BP or vascular stiffness are associated with increased risk of proteinuria in patients with chronic kidney disease (CKD) is unknown.
  
  
  METHODS
  Measurements of central and brachial artery BP, and aortic pulse wave velocity (PWV) were performed in a cross-sectional cohort of patients with CKD (n = 2144) from the Chronic Renal Insufficiency Cohort (CRIC) study to determine factors which predict increased risk of proteinuria. Multivariate analysis stratified by diabetes included age, ethnicity, gender, estimated glomerular filtration rate (GFR), waistline, smoking, heart rate, and medications to evaluate the relationship of hemodynamic factors and proteinuria.
  
  
  RESULTS
  Brachial artery systolic BP (SBP) was important as an explanatory factor for variations in proteinuria among both diabetics (R(2) = 0.40, P < 0.0001) and non diabetics (R(2) = 0.38, P < 0.001). Measures of peripheral pulse pressure (PP), central SBP, and central pulse pressure added little to the explained variation in proteinuria beyond brachial artery SBP, whereas PWV as a measure of vascular stiffness incrementally accounted for a significant portion of variation in proteinuria beyond that explained by brachial artery SBP in diabetics (R(2) = 0.42, P < 0.001) but not non diabetics.
  
  
  CONCLUSIONS
  Brachial artery SBP and PWV are both associated with variations in proteinuria in patients with CKD.
authors.affiliation: Division of Nephrology, University of Maryland School of Medicine Medical Center, Baltimore, MD 21201, USA. mweir@medicine.umaryland.edu
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Weir
authors.forename: Raymond R
authors.initials: RR
authors.lastname: Townsend
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Fink
authors.forename: Valerie
authors.initials: V
authors.lastname: Teal
authors.forename: Cheryl
authors.initials: C
authors.lastname: Anderson
authors.forename: Lawrence
authors.initials: L
authors.lastname: Appel
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
authors.forename: Jiang
authors.initials: J
authors.lastname: He
authors.forename: Natasha
authors.initials: N
authors.lastname: Litbarg
authors.forename: Akinlolu
authors.initials: A
authors.lastname: Ojo
authors.forename: Mahboob
authors.initials: M
authors.lastname: Rahman
authors.forename: Leigh
authors.initials: L
authors.lastname: Rosen
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Sozio
authors.forename: Susan
authors.initials: S
authors.lastname: Steigerwalt
authors.forename: Louise
authors.initials: L
authors.lastname: Strauss
authors.forename: Marshall M
authors.initials: MM
authors.lastname: Joffe
mesh_terms: D000368:Aged; D001011:Aorta / Q000503:physiopathology; D001794:Blood Pressure; D001916:Brachial Artery / Q000503:physiopathology*; D002908:Chronic Disease; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003928:Diabetic Nephropathies / Q000150:complications / Q000503:physiopathology; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011507:Proteinuria / Q000209:etiology* / Q000503:physiopathology*; D011673:Pulsatile Flow; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States