title: High Ambulatory Arterial Stiffness Index Is an Independent Risk Factor for Rapid Age-Related Glomerular Filtration Rate Decline in the General Middle-Aged Population.
abstract: Arterial stiffness is a risk factor for cardiovascular and chronic kidney disease. However, the role of arterial stiffness as a predictor of the age-related glomerular filtration rate (GFR) decline in the general population remains unresolved because of difficulty in measuring GFR with sufficient precision in epidemiological studies. The ambulatory arterial stiffness index (AASI) is a proposed indicator of arterial stiffness easily calculated from ambulatory blood pressure. We investigated whether AASI could predict GFR decline measured as iohexol clearance in the general population. We calculated AASI from baseline ambulatory blood pressure and measured the iohexol clearance at baseline and follow-up in the RENIS-FU study (Renal Iohexol Clearance Survey Follow-Up). AASI was defined as 1 minus the regression slope of the diastolic blood pressure measurement over the systolic blood pressure measurement for each patient. The RENIS cohort included a representative sample of the general middle-aged population without baseline diabetes mellitus, cardiovascular disease, or kidney disease (n=1608). The participant age was 50 to 62 years old at baseline, and the median observation time was 5.6 years. The mean (SD) of the GFR decline rate was 0.95 mL/min per year (2.23) and that of the AASI was 0.38 mL/min per year (0.13). Baseline ambulatory blood pressure or the night/day systolic or diastolic ambulatory blood pressure ratios were not associated with GFR decline. In multivariable-adjusted linear mixed regression analysis, 1 SD of increase in the baseline AASI was associated with a 0.14 mL/min per year (95% confidence interval, -0.26 to -0.02) steeper GFR decline. We conclude that the AASI is an independent risk factor for accelerated age-related GFR decline in the general middle-aged population.
authors.affiliation: From the Metabolic and Renal Research Group (B.O.E., V.T.N.S., T.G.J., U.D.M., J.S., M.D.S., T.M.), Department of Community Medicine, Faculty of Health Sciences (T.W.), UiT The Arctic University of Norway; Section of Nephrology, University Hospital of North Norway (B.O.E., U.D.M., M.D.S., T.M.); and Department of Transplant Medicine, Oslo University Hospital, Norway (T.G.J.). bjorn.odvar.eriksen@unn.no.
authors.forename: Bjørn Odvar
authors.initials: BO
authors.lastname: Eriksen
authors.affiliation: From the Metabolic and Renal Research Group (B.O.E., V.T.N.S., T.G.J., U.D.M., J.S., M.D.S., T.M.), Department of Community Medicine, Faculty of Health Sciences (T.W.), UiT The Arctic University of Norway; Section of Nephrology, University Hospital of North Norway (B.O.E., U.D.M., M.D.S., T.M.); and Department of Transplant Medicine, Oslo University Hospital, Norway (T.G.J.).
authors.forename: Vidar Tor Nyborg
authors.initials: VTN
authors.lastname: Stefansson
authors.affiliation: From the Metabolic and Renal Research Group (B.O.E., V.T.N.S., T.G.J., U.D.M., J.S., M.D.S., T.M.), Department of Community Medicine, Faculty of Health Sciences (T.W.), UiT The Arctic University of Norway; Section of Nephrology, University Hospital of North Norway (B.O.E., U.D.M., M.D.S., T.M.); and Department of Transplant Medicine, Oslo University Hospital, Norway (T.G.J.).
authors.forename: Trond Geir
authors.initials: TG
authors.lastname: Jenssen
authors.affiliation: From the Metabolic and Renal Research Group (B.O.E., V.T.N.S., T.G.J., U.D.M., J.S., M.D.S., T.M.), Department of Community Medicine, Faculty of Health Sciences (T.W.), UiT The Arctic University of Norway; Section of Nephrology, University Hospital of North Norway (B.O.E., U.D.M., M.D.S., T.M.); and Department of Transplant Medicine, Oslo University Hospital, Norway (T.G.J.).
authors.forename: Ulla Dorte
authors.initials: UD
authors.lastname: Mathisen
authors.affiliation: From the Metabolic and Renal Research Group (B.O.E., V.T.N.S., T.G.J., U.D.M., J.S., M.D.S., T.M.), Department of Community Medicine, Faculty of Health Sciences (T.W.), UiT The Arctic University of Norway; Section of Nephrology, University Hospital of North Norway (B.O.E., U.D.M., M.D.S., T.M.); and Department of Transplant Medicine, Oslo University Hospital, Norway (T.G.J.).
authors.forename: Jørgen
authors.initials: J
authors.lastname: Schei
authors.affiliation: From the Metabolic and Renal Research Group (B.O.E., V.T.N.S., T.G.J., U.D.M., J.S., M.D.S., T.M.), Department of Community Medicine, Faculty of Health Sciences (T.W.), UiT The Arctic University of Norway; Section of Nephrology, University Hospital of North Norway (B.O.E., U.D.M., M.D.S., T.M.); and Department of Transplant Medicine, Oslo University Hospital, Norway (T.G.J.).
authors.forename: Marit Dahl
authors.initials: MD
authors.lastname: Solbu
authors.affiliation: From the Metabolic and Renal Research Group (B.O.E., V.T.N.S., T.G.J., U.D.M., J.S., M.D.S., T.M.), Department of Community Medicine, Faculty of Health Sciences (T.W.), UiT The Arctic University of Norway; Section of Nephrology, University Hospital of North Norway (B.O.E., U.D.M., M.D.S., T.M.); and Department of Transplant Medicine, Oslo University Hospital, Norway (T.G.J.).
authors.forename: Tom
authors.initials: T
authors.lastname: Wilsgaard
authors.affiliation: From the Metabolic and Renal Research Group (B.O.E., V.T.N.S., T.G.J., U.D.M., J.S., M.D.S., T.M.), Department of Community Medicine, Faculty of Health Sciences (T.W.), UiT The Arctic University of Norway; Section of Nephrology, University Hospital of North Norway (B.O.E., U.D.M., M.D.S., T.M.); and Department of Transplant Medicine, Oslo University Hospital, Norway (T.G.J.).
authors.forename: Toralf
authors.initials: T
authors.lastname: Melsom
mesh_terms: D000367:Age Factors; D000375:Aging; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D059289:Vascular Stiffness / Q000502:physiology*
keywords: aging; atherosclerosis; geriatrics; glomerular filtration rate; renal insufficiency, chronic