Aortic PWV in Chronic Kidney Disease: A CRIC Ancillary Study

Townsend, Raymond R.; Wimmer, Neil J.; Chirinos, Julio A.; Parsa, Afshin; Weir, Matthew R.; Perumal, Kalyani; Lash, James P.; Chen, Jing; Steigerwalt, Susan; Flack, John M.; Go, Alan S.; Rafey, Mohammed A.; Rahman, Mahboob; Sheridan, Angela; Gadegbeku, Crystal A.; Robinson, Nancy; Joffe, Marshall M.

doi:10.1038/ajh.2009.240

Cited by 196 publications

(187 citation statements)

References 36 publications

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“…Previously we have reported, in these same CRIC cohort study participants, the independent positive associations of age, blood glucose concentration, AfricanAmerican ethnicity, waist circumference, mean arterial BP, male gender, and the presence of diabetes with PWV, and a significant negative association with the level of kidney function (20). These same observations were strikingly similar with our dependent variable, which was the log transformed 24-hour urine protein level.…”

Section: Discussionsupporting

confidence: 77%

“…Aortic pulse wave measurements were performed the same day as the BP measurements (20). These were performed supine after at least 5 minutes of rest, using the right carotid and right femoral arteries.…”

Section: Methodsmentioning

confidence: 99%

“…Briefly, in the supine position, the probe was centered over the radial artery with continuous real-time monitoring on a laptop computer at bedside. Once 10 seconds of stable waveform were obtained, the tracing was saved and the data quality for pulse wave analysis analyzed immediately for preestablished quality parameters (20,22). If these parameters were not met, the study was repeated.…”

Section: Methodsmentioning

confidence: 99%

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Hemodynamic Correlates of Proteinuria in Chronic Kidney Disease

Weir

Townsend

Fink

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Brachial artery measures of BP are associated with increasing degrees of proteinuria. Whether central measures of BP or vascular stiffness are associated with increased risk of proteinuria in patients with chronic kidney disease (CKD) is unknown.Design, setting, participants, & measurements Measurements of central and brachial artery BP, and aortic pulse wave velocity (PWV) were performed in a cross-sectional cohort of patients with CKD (n ϭ 2144) from the Chronic Renal Insufficiency Cohort (CRIC) study to determine factors which predict increased risk of proteinuria. Multivariate analysis stratified by diabetes included age, ethnicity, gender, estimated glomerular filtration rate (GFR), waistline, smoking, heart rate, and medications to evaluate the relationship of hemodynamic factors and proteinuria.Results Brachial artery systolic BP (SBP) was important as an explanatory factor for variations in proteinuria among both diabetics (R 2 ϭ 0.40, P Ͻ 0.0001) and non diabetics (R 2 ϭ 0.38, P Ͻ 0.001). Measures of peripheral pulse pressure (PP), central SBP, and central pulse pressure added little to the explained variation in proteinuria beyond brachial artery SBP, whereas PWV as a measure of vascular stiffness incrementally accounted for a significant portion of variation in proteinuria beyond that explained by brachial artery SBP in diabetics (R 2 ϭ 0.42, P Ͻ 0.001) but not non diabetics.Conclusions Brachial artery SBP and PWV are both associated with variations in proteinuria in patients with CKD.

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Section: Discussionsupporting

confidence: 77%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Hemodynamic Correlates of Proteinuria in Chronic Kidney Disease

Weir

Townsend

Fink

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…Aortic PWV was measured in CRIC participants at the year-2 follow-up visit and then every other year thereafter. The protocol for measuring PWV has been described previously (26). For the purposes of these analyses, PWV measurements were selected on the basis of the following priority: (1) within 30 days of the ABPM, (2) next PWV measurement after ABPM, and (3) most recent PWV measurement before ABPM.…”

Section: Study Outcomes-target Organ Damagementioning

confidence: 99%

Masked Hypertension and Elevated Nighttime Blood Pressure in CKD

Drawz¹,

Alper²,

Anderson³

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background and objectives Masked hypertension and elevated nighttime BP are associated with increased risk of hypertensive target organ damage and adverse cardiovascular and renal outcomes in patients with normal kidney function. The significance of masked hypertension for these risks in patients with CKD is less well defined. The objective of this study was to evaluate the association between masked hypertension and kidney function and markers of cardiovascular target organ damage, and to determine whether this relationship was consistent among those with and without elevated nighttime BP.Design, setting, participants, & measurements This was a cross-sectional study. We performed 24-hour ambulatory BP in 1492 men and women with CKD enrolled in the Chronic Renal Insufficiency Cohort Study. We categorized participants into controlled BP, white-coat, masked, and sustained hypertension on the basis of clinic and 24-hour ambulatory BP. We obtained echocardiograms and measured pulse wave velocity in 1278 and 1394 participants, respectively. ResultsThe percentages of participants with controlled BP, white-coat, masked, and sustained hypertension were 49.3%, 4.1%, 27.8%, and 18.8%, respectively. Compared with controlled BP, masked hypertension independently associated with low eGFR (23.2 ml/min per 1.73 m 2 ; 95% confidence interval, 25.5 to 20.9), higher proteinuria (+0.9 unit higher in log 2 urine protein; 95% confidence interval, 0.7 to 1.1), and higher left ventricular mass index (+2.52 g/m 2.7 ; 95% confidence interval, 0.9 to 4.1), and pulse wave velocity (+0.92 m/s; 95% confidence interval, 0.5 to 1.3). Participants with masked hypertension had lower eGFR only in the presence of elevated nighttime BP (23.6 ml/min per 1.73 m 2 ; 95% confidence interval, 26.1 to 21.1; versus 21.4 ml/min per 1.73 m 2 ; 95% confidence interval, 26.9 to 4.0, among those with nighttime BP ,120/70 mmHg; P value for interaction with nighttime systolic BP 0.002).Conclusions Masked hypertension is common in patients with CKD and associated with lower eGFR, proteinuria, and cardiovascular target organ damage. In patients with CKD, ambulatory BP characterizes the relationship between BP and target organ damage better than BP measured in the clinic alone.

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“…Carotid to femoral pulse wave velocity (PWV) is a simple and reproducible method to measure aortic stiffness, and is highly predictive of cardiovascular mortality in patients with end‐stage renal disease10 and kidney transplant and CKD,3, 11 which is remarkable in the absence of predictive equations in these populations. We and others have shown that not only aortic stiffness but also internal diameter enlargement, thinning of the arterial wall, increased circumferential wall stress, and reduction of the arterial distensibility occur early during CKD and progress in parallel with the fall in renal function and influence prognosis 1, 2, 3, 4, 12…”

Section: Introductionmentioning

confidence: 96%

Reversal of Arterial Stiffness and Maladaptative Arterial Remodeling After Kidney Transplantation

Karras

Boutouyrie

Briet

et al. 2017

JAHA

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BackgroundChronic kidney disease is characterized by stiffening, thinning, dilatation, and increased circumferential wall stress of large arteries, associated with increased cardiovascular risk. Kidney transplantation (KT) reverses many pathological features of chronic kidney disease and improves life expectancy; however, longitudinal studies exploring the impact of KT on recipient large arteries are scarce.Methods and ResultsThis study was designed to appraise arterial changes following KT. Carotid‐femoral pulse wave velocity, carotid remodeling (circumferential wall stress and carotid internal diameter), and stiffness were measured in 161 consecutive recipients receiving either a living (n=49) or a deceased (n=112) donor allograft, at 3 and 12 months after transplantation. Mean pulse wave velocity decreased from 10.8 m/s (95% confidence interval, 10.5–11.2 m/s) (at month 3) to 10.1 m/s (95% confidence interval, 9.8–10.5 m/s) (at month 12) (P<0.001). After multivariate adjustment, pulse wave velocity reduction from month 3 to month 12 was significantly larger in the living donor allograft KT (P<0.001). Circumferential wall stress decreased, 70 kPa (95% confidence interval, 68–72 kPa) to 64 kPa (95% confidence interval, 62–67 kPa), as well as carotid internal diameter and carotid stiffness (P<0.001 for all). Reductions in circumferential wall stress, diameter, and stiffness were significantly larger in the living donor allograft KT (P<0.001). When deceased donor allograft patients were classified into standard and expanded criteria donors, changes in both pulse wave velocity and circumferential wall stress were blunted in expanded criteria donors. Changes were independent of graft function and blood pressure changes.ConclusionsLarge‐artery stiffness and maladaptive carotid artery remodeling of chronic kidney disease is partially reversed within 12 months of KT and appears unrelated to renal function. Improvements were independently associated with live organ donation. Our data suggest that expanded criteria donors may hamper vascular recovery.

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Aortic PWV in Chronic Kidney Disease: A CRIC Ancillary Study

Cited by 196 publications

References 36 publications

Hemodynamic Correlates of Proteinuria in Chronic Kidney Disease

Hemodynamic Correlates of Proteinuria in Chronic Kidney Disease

Masked Hypertension and Elevated Nighttime Blood Pressure in CKD

Reversal of Arterial Stiffness and Maladaptative Arterial Remodeling After Kidney Transplantation

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