title: The significance of micro- and macrovascular biomarkers on cardiovascular outcome in chronic kidney disease: a prospective cohort study.
abstract: Measures of small and large artery dysfunction have not been investigated in a single cohort for the prediction of cardiovascular (CV) events in patients with nondialysed (ND) chronic kidney disease (CKD). This prospective cohort study aimed to determine whether central pulse wave velocity (cPWV), central pulse pressure (CPP) or microvascular post-occlusive reactive hyperaemia area (PORHHA) independently predict CV events and mortality in CKD-ND. A total of 94 stage 1-5 CKD-ND (65.3±13.1 years; estimated glomerular filtration rate 35.3 (22.8-49.4) ml min(-1) per 1.73 m(2)) patients were followed-up for a median of 52 (36-65) months and had baseline cPWV and CPP measured by applanation tonometry and PORHHA by laser Doppler flowmetry. Multiple failure time Cox regression models were used to determine the predictive role of vascular parameters on CV mortality and events. Based on multiple linear regressions, baseline age, diabetes, CV disease, and systolic blood pressure (SBP) were independently related to cPWV (R(2)=0.3), SBP and PORHHA to CPP (R(2)=0.45), whereas CPP was the only parameter independently related to PORHHA (R(2)=0.16, all P<0.05). During follow-up, 41 CV events occurred (14 CV deaths). In univariate analyses, cPWV (1.07 (1.02-1.13) per m s(-1)), CPP (1.04 (1.01-1.07) per mm Hg) and lnPORHHA (0.70 (0.58-0.85) per ln(PU × s)) were all related to the outcome. Baseline diabetes (HR 3.07 (1.65-5.68)), lnFGF23 (fibroblast growth factor-23; 1.86 (1.13-3.06) per RU ml(-1)) and CPP (1.04 (1.01-1.07) per mm Hg) were independent predictors of CV events. The impaired pulsatile component of large arteries (CPP) independently of other vascular markers (cPWV, PORHHA) predicted CV outcomes in CKD-ND. CPP may integrate the information provided by cPWV and PORHHA.
authors.affiliation: First Department of Internal Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: O
authors.initials: O
authors.lastname: Cseprekál
authors.affiliation: First Department of Internal Medicine, Semmelweis University, Budapest, Hungary.|Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Egresits
authors.affiliation: First Department of Internal Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: Á
authors.initials: Á
authors.lastname: Tabák
authors.affiliation: Department of Family Medicine, Semmelweis University, Budapest, Hungary.|Department of Emergency Medicine, Uzsoki Hospital, Budapest, Hungary.
authors.forename: J
authors.initials: J
authors.lastname: Nemcsik
authors.affiliation: Department of Cardiology, St Imre University Teaching Hospital, Budapest, Hungary.
authors.forename: Z
authors.initials: Z
authors.lastname: Járai
authors.affiliation: Department of Cardiology, St Imre University Teaching Hospital, Budapest, Hungary.
authors.forename: L
authors.initials: L
authors.lastname: Babos
authors.affiliation: Department of Nephrology and Hypertension, St Imre University Teaching Hospital, Budapest, Hungary.
authors.forename: E
authors.initials: E
authors.lastname: Fodor
authors.affiliation: Angiology Division, St Imre University Teaching Hospital, Budapest, Hungary.
authors.forename: K
authors.initials: K
authors.lastname: Farkas
authors.affiliation: Department of Cardiology, St Imre University Teaching Hospital, Budapest, Hungary.
authors.forename: G
authors.initials: G
authors.lastname: Godina
authors.affiliation: Second Department of Internal Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: K I
authors.initials: KI
authors.lastname: Kárpáthi
authors.affiliation: Department of Nephrology and Hypertension, St Imre University Teaching Hospital, Budapest, Hungary.
authors.forename: L
authors.initials: L
authors.lastname: Kerkovits
authors.affiliation: Nephrology Division, Uzsoki Teaching Hospital, Budapest, Hungary.
authors.forename: A
authors.initials: A
authors.lastname: Marton
authors.affiliation: First Department of Internal Medicine, Semmelweis University, Budapest, Hungary.|Department of Radiology and Oncology, Semmelweis University, Budapest, Hungary.
authors.forename: Z
authors.initials: Z
authors.lastname: Nemcsik-Bencze
authors.affiliation: Nephrology Division, Uzsoki Teaching Hospital, Budapest, Hungary.
authors.forename: Z
authors.initials: Z
authors.lastname: Németh
authors.affiliation: Department of Cardiology, St Imre University Teaching Hospital, Budapest, Hungary.
authors.forename: L
authors.initials: L
authors.lastname: Sallai
authors.affiliation: Department of Nephrology and Hypertension, St Imre University Teaching Hospital, Budapest, Hungary.
authors.forename: I
authors.initials: I
authors.lastname: Kiss
authors.affiliation: First Department of Internal Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: A
authors.initials: A
authors.lastname: Tislér
mesh_terms: D000368:Aged; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011673:Pulsatile Flow; D063177:Pulse Wave Analysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D059289:Vascular Stiffness