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Determinants of arterial stiffness in chronic kidney disease stage 3

McIntyre, Natasha J.; Fluck, Richard J.; McIntyre, Christopher W.; Fakis, Apostolos; Taal, Maarten W.

Authors

Natasha J. McIntyre

Richard J. Fluck

Christopher W. McIntyre

Apostolos Fakis

Maarten W. Taal



Abstract

Background: Early chronic kidney disease (CKD) is associated with increased cardiovascular (CV) risk but underlying mechanisms remain uncertain. Arterial stiffness (AS) is associated with increased CV risk in advanced CKD, but it is unclear whether AS is relevant to CV disease (CVD) in early CKD.
Study Design: Cross-sectional.
Setting and participants: 1717 patients with previous estimated glomerular filtration rate (eGFR) 59–30 mL/min/1.73 m2;
mean age 7369y, were recruited from 32 general practices in primary care.
Outcomes: Increased arterial stiffness.
Measurements: Medical history was obtained and participants underwent clinical assessment, urine and serum biochemistry testing. Carotid to femoral pulse wave velocity (PWV) was determined as a measure of AS, using a VicorderTM device.
Results: Univariate analysis revealed significant correlations between PWV and risk factors for CVD including age (r = 0.456; p,0.001), mean arterial pressure (MAP) (r = 0.228; p,0.001), body mass index (r = 20.122; p,0.001), log urinary albumin to creatinine ratio (r = 0.124; p,0.001), Waist to Hip ratio (r = 0.124, p,0.001), eGFR (r = 20.074; p = 0.002), log high sensitivity c-reactive protein (r = 0.066; p = 0.006), HDL (r = 20.062; p = 0.01) and total cholesterol (r = 20.057; p = 0.02). PWV was higher in males (9.6 m/sec vs.10.3 m/sec; p,0.001), diabetics (9.8 m/sec vs. 10.3 m/sec; p,0.001), and those with previous CV events (CVE) (9.8 m/s vs. 10.3 m/sec; p,0.001). Multivariable analysis identified age, MAP and diabetes as strongest independent determinants of higher PWV (adjusted R2 = 0.29). An interactive term indicated that PWV increased to a greater extent with age in males versus females. Albuminuria was a weaker determinant of PWV and eGFR did not enter the model.
Limitations: Data derived from one study visit, with absence of normal controls.
Conclusion: In this cohort, age and traditional CV risk factors were the strongest determinants of AS. Albuminuria was a relatively weak determinant of AS and eGFR was not an independent determinant. Long-term follow-up will investigate AS as an independent risk factor for CVE in this cohort.

Journal Article Type Article
Publication Date Jan 30, 2013
Journal PLoS ONE
Electronic ISSN 1932-6203
Publisher Public Library of Science
Peer Reviewed Peer Reviewed
Volume 8
Issue 1
Article Number 6
Institution Citation McIntyre, N. J., Fluck, R. J., McIntyre, C. W., Fakis, A., & Taal, M. W. (2013). Determinants of arterial stiffness in chronic kidney disease stage 3. PLoS ONE, 8(1), doi:10.1371/journal.pone.0055444
DOI https://doi.org/10.1371/journal.pone.0055444
Publisher URL http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0055444
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0





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