title: Role of Pulse Wave Velocity in Patients with Chronic Kidney Disease Stages 3-5 on Long-Term Follow-Up.
abstract: BACKGROUND
  The relationship between arterial stiffness and kidney function has not been clearly demonstrated although observations of higher arterial stiffness in patients with advanced stages of chronic kidney disease (CKD) were reported. In longitudinal analyses, there was no close association between basal arterial stiffness and progression of kidney function in the general population. In the present study, we assessed the relationship between arterial stiffness and progression of renal dysfunction in patients with CKD stages 3-5 using two types of measures of arterial stiffness, i.e., carotid-femoral pulse wave velocity (cfPWV) and brachial-ankle pulse wave velocity (baPWV), over a 10-year period.
  
  
  METHODS
  110 patients with CKD stages 3-5 (aged 57.8 ± 10.6 years; female/male: 72/38) were followed for 10 years. Before and at the end of the 10-year period, cfPWV and baPWV were measured using form PWV/ABI (Omron Colin Co. Ltd.).
  
  
  RESULTS
  Throughout the study, systolic blood pressure was well-controlled in all patients. Twenty-nine patients (26%) received renal replacement therapy, 12 patients (11%) developed cardiovascular diseases (CVDs), 5 patients were found to have neoplasm, and 9 patients dropped out of the study during the 10-year observation period. In patients who developed end-stage renal disease, the baseline estimated glomerular filtration rate (eGFR) was significantly lower, and in patients who developed CVD, the basal value of baPWV was significantly higher (p < 0.05). Throughout the study, blood pressures were controlled (136.1/77.0 ± 15.6/7.1 to 137.5/77.6 ± 14.9/11.2), kidney function worsened (eGFR, 30.8 ± 16.5 to 22.9 ± 17.6 ml/min/1.73 m(2); p < 0.01), and baPWV but not cfPWV showed a significant change [1, 672.2 ± 209.6 vs. 1,753.1 ± 333.2 cm/s (p = 0.04) and 918.9 ± 153.2 vs. 939.4 ± 133.2 cm/s]. Moreover, the difference in PWV between the start and the end of the 10-year observation period was positively correlated with the difference in eGFR.
  
  
  CONCLUSIONS
  With moderate progression of renal dysfunction and under well-controlled blood pressure, peripheral but not central arterial stiffness is possibly one of the strongest predictors of CVD in patients with CKD stages 3-5.
authors.affiliation: Department of Nephrology, Saitama Medical University, Saitama, Japan.
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: Department of Nephrology, Saitama Medical University, Saitama, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Omron Health Care Co. Ltd., Kyoto, Japan.
authors.forename: Mami
authors.initials: M
authors.lastname: Dogi
authors.affiliation: Department of Nephrology, Saitama Medical University, Saitama, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Kikuta
authors.affiliation: Department of Nephrology, International University of Health and Welfare, Medical University Hospital, Tokyo, Japan.
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Takenaka
authors.affiliation: Department of Nephrology, Saitama Medical University, Saitama, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Okada
keywords: Blood pressure; Estimated glomerular filtration rate; Pulse wave velocity