title: Arterial stiffness, central pressures, and incident hospitalized heart failure in the chronic renal insufficiency cohort study.
abstract: BACKGROUND
  Chronic kidney disease is associated with an increased risk of heart failure (HF). We aimed to evaluate the role of large artery stiffness, brachial, and central blood pressure as predictors of incident hospitalized HF in the Chronic Renal Insufficiency Cohort (CRIC), a multiethnic, multicenter prospective observational study of patients with chronic kidney disease.
  
  
  RESULTS
  We studied 2602 participants who were free of HF at baseline. Carotid-femoral pulse wave velocity (CF-PWV; the gold standard index of large artery stiffness), brachial, and central pressures (estimated via radial tonometry and a generalized transfer function) were assessed at baseline. Participants were prospectively followed up to assess the development of new-onset hospitalized HF. During 3.5 years of follow-up, 154 participants had a first hospital admission for HF. CF-PWV was a significant independent predictor of incident hospitalized HF. When compared with the lowest tertile, the hazard ratios among subjects in the middle and top CF-PWV tertiles were 2.33 (95% confidence interval, 1.37-3.97; P=0.002) and 5.24 (95% confidence interval, 3.22-8.53; P<0.0001), respectively. After adjustment for multiple confounders, the hazard ratios for the middle and top CF-PWV tertiles were 1.95 (95% confidence interval, 0.92-4.13; P=0.079) and 3.01 (95% confidence interval, 1.45-6.26; P=0.003), respectively. Brachial systolic and pulse pressure were also independently associated with incident hospitalized HF, whereas central pressures were less consistently associated with this end point. The association between CF-PWV and incident HF persisted after adjustment for systolic blood pressure.
  
  
  CONCLUSIONS
  Large artery stiffness is an independent predictor of incident HF in chronic kidney disease, an association with strong biological plausibility given the known effects of large artery stiffening of left ventricular pulsatile load.
authors: From the Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., A.K., D.L.D., V.F., R.K., A.S., J.S., R.R.T.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C.); Department of Medicine, University of California, San Francisco (N.B.); Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (H.I.F., A.H.A., V.T.); Department of Medicine, University of Illinois, Chicago (J.P.L.); Department of Medicine, University of Michigan, Ann Arbor (A.O.); Department of Medicine, Cleveland Clinic Foundation, OH (M.S.); Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (J.R.); Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (Q.P.); and Division of Research, Department of Epidemiology and Biostatistics, Department of Medicine, Kaiser Permanente of Northern California, Oakland (A.S.G.). julio.chirinos@uphs.upenn.edu.
authors: Julio A
authors: JA
authors: Chirinos
authors: From the Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., A.K., D.L.D., V.F., R.K., A.S., J.S., R.R.T.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C.); Department of Medicine, University of California, San Francisco (N.B.); Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (H.I.F., A.H.A., V.T.); Department of Medicine, University of Illinois, Chicago (J.P.L.); Department of Medicine, University of Michigan, Ann Arbor (A.O.); Department of Medicine, Cleveland Clinic Foundation, OH (M.S.); Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (J.R.); Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (Q.P.); and Division of Research, Department of Epidemiology and Biostatistics, Department of Medicine, Kaiser Permanente of Northern California, Oakland (A.S.G.).
authors: Abigail
authors: A
authors: Khan
authors: From the Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., A.K., D.L.D., V.F., R.K., A.S., J.S., R.R.T.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C.); Department of Medicine, University of California, San Francisco (N.B.); Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (H.I.F., A.H.A., V.T.); Department of Medicine, University of Illinois, Chicago (J.P.L.); Department of Medicine, University of Michigan, Ann Arbor (A.O.); Department of Medicine, Cleveland Clinic Foundation, OH (M.S.); Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (J.R.); Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (Q.P.); and Division of Research, Department of Epidemiology and Biostatistics, Department of Medicine, Kaiser Permanente of Northern California, Oakland (A.S.G.).
authors: Nisha
authors: N
authors: Bansal
authors: From the Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., A.K., D.L.D., V.F., R.K., A.S., J.S., R.R.T.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C.); Department of Medicine, University of California, San Francisco (N.B.); Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (H.I.F., A.H.A., V.T.); Department of Medicine, University of Illinois, Chicago (J.P.L.); Department of Medicine, University of Michigan, Ann Arbor (A.O.); Department of Medicine, Cleveland Clinic Foundation, OH (M.S.); Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (J.R.); Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (Q.P.); and Division of Research, Department of Epidemiology and Biostatistics, Department of Medicine, Kaiser Permanente of Northern California, Oakland (A.S.G.).
authors: Daniel L
authors: DL
authors: Dries
authors: From the Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., A.K., D.L.D., V.F., R.K., A.S., J.S., R.R.T.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C.); Department of Medicine, University of California, San Francisco (N.B.); Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (H.I.F., A.H.A., V.T.); Department of Medicine, University of Illinois, Chicago (J.P.L.); Department of Medicine, University of Michigan, Ann Arbor (A.O.); Department of Medicine, Cleveland Clinic Foundation, OH (M.S.); Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (J.R.); Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (Q.P.); and Division of Research, Department of Epidemiology and Biostatistics, Department of Medicine, Kaiser Permanente of Northern California, Oakland (A.S.G.).
authors: Harold I
authors: HI
authors: Feldman
authors: From the Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., A.K., D.L.D., V.F., R.K., A.S., J.S., R.R.T.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C.); Department of Medicine, University of California, San Francisco (N.B.); Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (H.I.F., A.H.A., V.T.); Department of Medicine, University of Illinois, Chicago (J.P.L.); Department of Medicine, University of Michigan, Ann Arbor (A.O.); Department of Medicine, Cleveland Clinic Foundation, OH (M.S.); Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (J.R.); Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (Q.P.); and Division of Research, Department of Epidemiology and Biostatistics, Department of Medicine, Kaiser Permanente of Northern California, Oakland (A.S.G.).
authors: Virginia
authors: V
authors: Ford
authors: From the Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., A.K., D.L.D., V.F., R.K., A.S., J.S., R.R.T.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C.); Department of Medicine, University of California, San Francisco (N.B.); Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (H.I.F., A.H.A., V.T.); Department of Medicine, University of Illinois, Chicago (J.P.L.); Department of Medicine, University of Michigan, Ann Arbor (A.O.); Department of Medicine, Cleveland Clinic Foundation, OH (M.S.); Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (J.R.); Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (Q.P.); and Division of Research, Department of Epidemiology and Biostatistics, Department of Medicine, Kaiser Permanente of Northern California, Oakland (A.S.G.).
authors: Amanda H
authors: AH
authors: Anderson
authors: From the Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., A.K., D.L.D., V.F., R.K., A.S., J.S., R.R.T.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C.); Department of Medicine, University of California, San Francisco (N.B.); Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (H.I.F., A.H.A., V.T.); Department of Medicine, University of Illinois, Chicago (J.P.L.); Department of Medicine, University of Michigan, Ann Arbor (A.O.); Department of Medicine, Cleveland Clinic Foundation, OH (M.S.); Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (J.R.); Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (Q.P.); and Division of Research, Department of Epidemiology and Biostatistics, Department of Medicine, Kaiser Permanente of Northern California, Oakland (A.S.G.).
authors: Radhakrishna
authors: R
authors: Kallem
authors: From the Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., A.K., D.L.D., V.F., R.K., A.S., J.S., R.R.T.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C.); Department of Medicine, University of California, San Francisco (N.B.); Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (H.I.F., A.H.A., V.T.); Department of Medicine, University of Illinois, Chicago (J.P.L.); Department of Medicine, University of Michigan, Ann Arbor (A.O.); Department of Medicine, Cleveland Clinic Foundation, OH (M.S.); Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (J.R.); Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (Q.P.); and Division of Research, Department of Epidemiology and Biostatistics, Department of Medicine, Kaiser Permanente of Northern California, Oakland (A.S.G.).
authors: James P
authors: JP
authors: Lash
authors: From the Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., A.K., D.L.D., V.F., R.K., A.S., J.S., R.R.T.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C.); Department of Medicine, University of California, San Francisco (N.B.); Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (H.I.F., A.H.A., V.T.); Department of Medicine, University of Illinois, Chicago (J.P.L.); Department of Medicine, University of Michigan, Ann Arbor (A.O.); Department of Medicine, Cleveland Clinic Foundation, OH (M.S.); Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (J.R.); Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (Q.P.); and Division of Research, Department of Epidemiology and Biostatistics, Department of Medicine, Kaiser Permanente of Northern California, Oakland (A.S.G.).
authors: Akinlolu
authors: A
authors: Ojo
authors: From the Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., A.K., D.L.D., V.F., R.K., A.S., J.S., R.R.T.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C.); Department of Medicine, University of California, San Francisco (N.B.); Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (H.I.F., A.H.A., V.T.); Department of Medicine, University of Illinois, Chicago (J.P.L.); Department of Medicine, University of Michigan, Ann Arbor (A.O.); Department of Medicine, Cleveland Clinic Foundation, OH (M.S.); Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (J.R.); Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (Q.P.); and Division of Research, Department of Epidemiology and Biostatistics, Department of Medicine, Kaiser Permanente of Northern California, Oakland (A.S.G.).
authors: Martin
authors: M
authors: Schreiber
authors: From the Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., A.K., D.L.D., V.F., R.K., A.S., J.S., R.R.T.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C.); Department of Medicine, University of California, San Francisco (N.B.); Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (H.I.F., A.H.A., V.T.); Department of Medicine, University of Illinois, Chicago (J.P.L.); Department of Medicine, University of Michigan, Ann Arbor (A.O.); Department of Medicine, Cleveland Clinic Foundation, OH (M.S.); Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (J.R.); Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (Q.P.); and Division of Research, Department of Epidemiology and Biostatistics, Department of Medicine, Kaiser Permanente of Northern California, Oakland (A.S.G.).
authors: Angela
authors: A
authors: Sheridan
authors: From the Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., A.K., D.L.D., V.F., R.K., A.S., J.S., R.R.T.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C.); Department of Medicine, University of California, San Francisco (N.B.); Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (H.I.F., A.H.A., V.T.); Department of Medicine, University of Illinois, Chicago (J.P.L.); Department of Medicine, University of Michigan, Ann Arbor (A.O.); Department of Medicine, Cleveland Clinic Foundation, OH (M.S.); Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (J.R.); Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (Q.P.); and Division of Research, Department of Epidemiology and Biostatistics, Department of Medicine, Kaiser Permanente of Northern California, Oakland (A.S.G.).
authors: Jillian
authors: J
authors: Strelsin
authors: From the Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., A.K., D.L.D., V.F., R.K., A.S., J.S., R.R.T.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C.); Department of Medicine, University of California, San Francisco (N.B.); Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (H.I.F., A.H.A., V.T.); Department of Medicine, University of Illinois, Chicago (J.P.L.); Department of Medicine, University of Michigan, Ann Arbor (A.O.); Department of Medicine, Cleveland Clinic Foundation, OH (M.S.); Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (J.R.); Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (Q.P.); and Division of Research, Department of Epidemiology and Biostatistics, Department of Medicine, Kaiser Permanente of Northern California, Oakland (A.S.G.).
authors: Valerie
authors: V
authors: Teal
authors: From the Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., A.K., D.L.D., V.F., R.K., A.S., J.S., R.R.T.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C.); Department of Medicine, University of California, San Francisco (N.B.); Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (H.I.F., A.H.A., V.T.); Department of Medicine, University of Illinois, Chicago (J.P.L.); Department of Medicine, University of Michigan, Ann Arbor (A.O.); Department of Medicine, Cleveland Clinic Foundation, OH (M.S.); Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (J.R.); Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (Q.P.); and Division of Research, Department of Epidemiology and Biostatistics, Department of Medicine, Kaiser Permanente of Northern California, Oakland (A.S.G.).
authors: Jason
authors: J
authors: Roy
authors: From the Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., A.K., D.L.D., V.F., R.K., A.S., J.S., R.R.T.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C.); Department of Medicine, University of California, San Francisco (N.B.); Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (H.I.F., A.H.A., V.T.); Department of Medicine, University of Illinois, Chicago (J.P.L.); Department of Medicine, University of Michigan, Ann Arbor (A.O.); Department of Medicine, Cleveland Clinic Foundation, OH (M.S.); Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (J.R.); Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (Q.P.); and Division of Research, Department of Epidemiology and Biostatistics, Department of Medicine, Kaiser Permanente of Northern California, Oakland (A.S.G.).
authors: Qiang
authors: Q
authors: Pan
authors: From the Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., A.K., D.L.D., V.F., R.K., A.S., J.S., R.R.T.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C.); Department of Medicine, University of California, San Francisco (N.B.); Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (H.I.F., A.H.A., V.T.); Department of Medicine, University of Illinois, Chicago (J.P.L.); Department of Medicine, University of Michigan, Ann Arbor (A.O.); Department of Medicine, Cleveland Clinic Foundation, OH (M.S.); Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (J.R.); Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (Q.P.); and Division of Research, Department of Epidemiology and Biostatistics, Department of Medicine, Kaiser Permanente of Northern California, Oakland (A.S.G.).
authors: Alan S
authors: AS
authors: Go
authors: From the Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., A.K., D.L.D., V.F., R.K., A.S., J.S., R.R.T.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C.); Department of Medicine, University of California, San Francisco (N.B.); Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (H.I.F., A.H.A., V.T.); Department of Medicine, University of Illinois, Chicago (J.P.L.); Department of Medicine, University of Michigan, Ann Arbor (A.O.); Department of Medicine, Cleveland Clinic Foundation, OH (M.S.); Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (J.R.); Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (Q.P.); and Division of Research, Department of Epidemiology and Biostatistics, Department of Medicine, Kaiser Permanente of Northern California, Oakland (A.S.G.).
authors: Raymond R
authors: RR
authors: Townsend
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination; D001916:Brachial Artery / Q000503:physiopathology; D005260:Female; D005263:Femoral Artery / Q000503:physiopathology; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017534:Radial Artery / Q000503:physiopathology; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D014481:United States / Q000453:epidemiology; D059289:Vascular Stiffness / Q000502:physiology*; D055815:Young Adult
keywords: heart failure; pulse wave analysis; renal insufficiency, chronic; vascular stiffness