title: Aortic stiffness and change in glomerular filtration rate and albuminuria in older people.
abstract: BACKGROUND
  Aortic stiffness increases with age and increases pulsatile stress in the microcirculation. Abnormalities in kidney microvascular structure and function may contribute to development or progression of chronic kidney disease in older people.
  
  
  METHODS
  We performed a longitudinal analysis of 629 community-dwelling elderly Icelandic adults from the Age, Gene/Environment Susceptibility-Reykjavik Study with two visits over a mean follow-up of 5.3 years. We evaluated the associations of carotid-femoral pulse wave velocity (CFPWV), carotid pulse pressure (CPP) and augmentation index (AI), with the change in estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) assessed as annual change and dichotomized as large changes. Models were adjusted for age, sex, height, heart rate, traditional cardiovascular disease risk factors and baseline kidney measures.
  
  
  RESULTS
  When eGFR was analyzed as a continuous variable, higher baseline CFPWV and CPP, but not AI, were significantly associated with a larger annual decline in eGFR in models adjusted for age, sex, height, heart rate and baseline eGFR, but not after additional adjustment for the mean arterial pressure. When eGFR was analyzed as a categorical variable, higher CFPWV was significantly associated with a decrease in eGFR of ≥3 mL/min/1.73 m 2 /year [odds ratio (OR) 1.53, 95% confidence interval (CI) 1.11-2.13] and higher AI was associated with 30% eGFR decline during follow-up (OR 1.44 and 95% CI 1.03-2.00) in fully adjusted models. None of the tonometry measures was associated with change in UACR.
  
  
  CONCLUSIONS
  Abnormalities in vascular health may play a role in large declines in eGFR beyond the traditional cardiovascular disease risks in this older Icelandic cohort.
authors.affiliation: The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Naya
authors.initials: N
authors.lastname: Huang
authors.affiliation: Tufts Medical Center, Boston, MA, USA.
authors.forename: Meredith C
authors.initials: MC
authors.lastname: Foster
authors.affiliation: Cardiovascular Engineering, Inc., Norwood, MA, USA.
authors.forename: Gary F
authors.initials: GF
authors.lastname: Mitchell
authors.affiliation: Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.
authors.forename: Margret B
authors.initials: MB
authors.lastname: Andresdottir
authors.affiliation: Icelandic Heart Association, Kopavogur, Iceland.
authors.forename: Gudny
authors.initials: G
authors.lastname: Eiriksdottir
authors.affiliation: Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.|University of Iceland, Reykjavik, Iceland.
authors.forename: Hrefna
authors.initials: H
authors.lastname: Gudmundsdottir
authors.affiliation: National Institute on Aging, Bethesda, MD, USA.
authors.forename: Tamara B
authors.initials: TB
authors.lastname: Harris
authors.affiliation: National Institute on Aging, Bethesda, MD, USA.
authors.forename: Lenore J
authors.initials: LJ
authors.lastname: Launer
authors.affiliation: Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.|University of Iceland, Reykjavik, Iceland.
authors.forename: Runolfur
authors.initials: R
authors.lastname: Palsson
authors.affiliation: Icelandic Heart Association, Kopavogur, Iceland.|University of Iceland, Reykjavik, Iceland.
authors.forename: Vilmundur
authors.initials: V
authors.lastname: Gudnason
authors.affiliation: Tufts Medical Center, Boston, MA, USA.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Levey
authors.affiliation: Tufts Medical Center, Boston, MA, USA.
authors.forename: Lesley A
authors.initials: LA
authors.lastname: Inker
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000453:epidemiology*; D001011:Aorta / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D063177:Pulse Wave Analysis; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D059289:Vascular Stiffness
keywords: albuminuria; aortic stiffness; chronic kidney disease; estimated glomerular filtration; older people