title: Aortic pulse wave velocity predicts mortality in chronic kidney disease stages 2-4.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is characterized by aortic stiffness and increased cardiovascular mortality. In end-stage renal disease, aortic stiffness predicts mortality, whereas this role remains uncertain in mild-to-moderate CKD. We aimed to investigate whether aortic pulse wave velocity (aPWV) predicts mortality and renal disease progression in CKD patients.
  
  
  METHODS
  We enrolled 135 CKD patients stages 2-4 [estimated glomerular filtration rate (eGFR): 41.1 (28.5-61.6) ml/min per 1.73  m] in the study and assessed aPWV. The combined renal end-point was defined as at least 50% decline in renal function and/or start of renal replacement therapy.
  
  
  RESULTS
  During the observational period of 42 (30-50) months six patients were lost of follow-up, 13 patients died and 16 patients reached the combined renal end-point. Stratification according to the mean of aPWV (10  m/s), Kaplan-Meier analysis revealed increased mortality with aPWV ≥10  m/s (log-rank P < 0.05). Stepwise logistic regression analysis confirmed aPWV as an independent predictor for mortality in CKD stage 2-4. The hazard ratio of mortality in the cohort with an aPWV at least 10  m/s was 5.1 (1.1-22.9). By contrast, Kaplan-Meier analysis revealed no effect of aPWV on the combined renal end-point (log-rank P = 0.90).
  
  
  CONCLUSIONS
  These results provide the first direct evidence that in patients with CKD stage 2-4, increased aortic stiffness determined by aPWV is a strong independent predictor of all-cause mortality.
authors.affiliation: aDepartment of Nephrology, Klinikum rechts der Isar, Technische Universität München, Germany bHealth & Environment Department, AIT Austrian Institute of Technology, Vienna, Austria cNephrological Clinic Weissenburg, Weissenburg, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Baumann
authors.forename: Siegfried
authors.initials: S
authors.lastname: Wassertheurer
authors.forename: Yana
authors.initials: Y
authors.lastname: Suttmann
authors.forename: Klaus
authors.initials: K
authors.lastname: Burkhardt
authors.forename: Uwe
authors.initials: U
authors.lastname: Heemann
mesh_terms: D000368:Aged; D001011:Aorta / Q000473:pathology* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011446:Prospective Studies; D063177:Pulse Wave Analysis; D012044:Regression Analysis; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology*; D017582:Renal Replacement Therapy; D059289:Vascular Stiffness