Abstract 546: Arterial Stiffness And Pulse Pressure Predict Kidney Disease Progression In Chronic Kidney Disease
Brachial pulse pressure (bPP) predicts kidney function in CKD. Pulse wave velocity (PWV) may provide additional prediction of CKD progression, and was evaluated longitudinally in CKD patients enrolled in the CRIC cohort. bPP was used because it shows superior CKD progression prediction in humans.
There were 2821 participants in CRIC who underwent an assessment of PWV most of whom were studied at their second year follow-up visit. Of these 43 % were women, 48% diabetic, mean age 60 years and mean estimated GFR of 44.6 mL/min/1.73m2. Blacks were 40%, whites 44%, and Hispanics 12%. Mean blood pressure was 127/70 mmHg; mean bPP was 54 mmHg. The interaction of PWV with bPP on the occurrence of ESRD (dialysis or a transplant) [left panel of figure] and a combined endpoint of halving of the eGFR or ESRD [right panel], was analyzed used Cox regression. Events by tertiles of PWV (<7.9 msec; 7.9-10.3 m/sec; >10.3m/sec) and bPP (<46 mmHg, 46-62 mmHg, >62 mmHg) are shown in the figure.
There were significant interactions between PWV and bPP for both outcomes. For ESRD the hazard ratio of the highest tertiles of PWV/bPP compared with the lowest was 3.18 (p<0.001). For the combined ESRD or halving of eGFR the HR was 2.65 (p<0.001). In multivariable regression important predictors of CKD progression in this model were age, male gender, non-white race/ethnicity, initial eGFR, and proteinuria.PWV showed a strong and graded interaction with bPP in the prediction of ESRD and the combined outcome of halving of GFR or ESRD. A greater appreciation of the role of arterial stiffness in CKD is an important step towards pursuing the mechanisms underlying how this measure may influence the course of kidney disease progression.
Author Disclosures: R. Townsend: B. Research Grant (includes principal investigator, collaborator, or consultant and pending grants as well as grants already received); Significant; NIH. N. Bansal: None. J. Chirinos: None. M. Cuevas: None. V. Ford: None. J. Grunwald: None. C. Hsu: None. J. Roy: None. K. Kallem: None. M. Rahman: None. B. Chai: None. M. Weir: None. J. Wright: None. H.I. Feldman: None.
- © 2014 by American Heart Association, Inc.