title: Association of pulse pressure, arterial elasticity, and endothelial function with kidney function decline among adults with estimated GFR >60 mL/min/1.73 m(2): the Multi-Ethnic Study of Atherosclerosis (MESA).
abstract: BACKGROUND
  The association of subclinical vascular disease and early declines in kidney function has not been well studied.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Multi-Ethnic Study of Atherosclerosis (MESA) participants with estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m(2) with follow-up of 5 years.
  
  
  METHODS
  Pulse pressure, small (SAE) and large arterial elasticity (LAE), and flow-mediated dilation.
  
  
  RESULTS
  Kidney function decline.
  
  
  METHODS
  SAE and LAE were measured by pulse contour analysis of the radial artery. Kidney function was assessed by eGFR based on serum creatinine (eGFR(SCr)) and cystatin C (eGFR(SCysC)).
  
  
  RESULTS
  For 4,853 adults, higher pulse pressure and lower SAE and LAE had independent and linear associations with faster rates of kidney function decline. Compared with persons with pulse pressure of 40-50 mm Hg, eGFR(SCysC) declines were 0.29 (P = 0.006), 0.56 (P < 0.001), and 0.91 (P < 0.001) mL/min/1.73 m(2)/y faster in persons with pulse pressure of 50-60, 60-70, and >70 mm Hg, respectively. Compared with the highest quartile of SAE (most elastic), eGFR(SCysC) declines were 0.26 (P = 0.009), 0.35 (P = 0.001), and 0.70 (P < 0.001) mL/min/1.73 m(2)/y faster for the second, third, and fourth quartiles, respectively. For LAE, compared with the highest quartile, eGFR(SCysC) declines were 0.28 (P = 0.004), 0.58 (P < 0.001), and 0.83 (P < 0.001) mL/min/1.73 m(2)/y faster for each decreasing quartile of LAE. Findings were similar for eGFR(SCr). In contrast, for 2,997 adults with flow-mediated dilation and kidney function measures, flow-mediated dilation was not associated significantly with kidney function decline. For every 1-standard deviation greater flow-mediated dilation, eGFR(SCysC) and eGFR(SCr) changed by 0.05 (P = 0.3) and 0.06 mL/min/1.73 m(2)/y (P = 0.04), respectively.
  
  
  CONCLUSIONS
  We had no direct measure of GFR, in common with nearly all large population-based studies.
  
  
  CONCLUSIONS
  Higher pulse pressure and lower arterial elasticity, but not flow-mediated dilation, were associated linearly and independently with faster kidney function decline in persons with eGFR ≥60 mL/min/1.73 m(2). Future studies should investigate whether treatments to decrease the stiffness of large and small arteries may slow the rate of kidney function loss.
authors: San Francisco VA Medical Center, San Francisco, CA; University of California, San Francisco, CA 94121, USA. carmenalicia.peralta@ucsf.edu
authors: Carmen A
authors: CA
authors: Peralta
authors: David R
authors: DR
authors: Jacobs
authors: Ronit
authors: R
authors: Katz
authors: Joachim H
authors: JH
authors: Ix
authors: Magdalena
authors: M
authors: Madero
authors: Daniel A
authors: DA
authors: Duprez
authors: Mark J
authors: MJ
authors: Sarnak
authors: Michael H
authors: MH
authors: Criqui
authors: Holly J
authors: HJ
authors: Kramer
authors: Walter
authors: W
authors: Palmas
authors: David
authors: D
authors: Herrington
authors: Michael G
authors: MG
authors: Shlipak
mesh_terms: D001158:Arteries / Q000503:physiopathology*; D001794:Blood Pressure; D002908:Chronic Disease; D004548:Elasticity; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies