Brachial-Ankle Pulse Wave Velocity and Rate of Renal Function Decline and Mortality in Chronic Kidney Disease

Abstract

SummaryBackground and objectives Increased arterial stiffness was reported to be associated with decreased estimated GFR (eGFR). Previous studies suggested that arterial stiffness might play a role in renal function progression in patients with chronic kidney disease (CKD). The aim of this study was to investigate whether there was an independent association between brachial-ankle pulse wave velocity (baPWV), a marker of arterial stiffness, and renal function progression in CKD patients.Design, setting, participants, & measurements This longitudinal study enrolled 145 patients with CKD stages 3 to 5. The baPWV was measured by using an ABI-form device. The change in renal function was estimated by eGFR slope. The study endpoints were defined as commencement of dialysis or death.Results After a stepwise multivariate analysis, the eGFR slope was positively associated with baseline eGFR and negatively associated with hypertension and baPWV (␤ ϭ Ϫ0.165, P ϭ 0.033). Seventeen patients entering dialysis, and eight deaths were recorded. Multivariate forward Cox regression analysis identified that higher baPWV (hazard ratio, 1.001; P ϭ 0.001), lower baseline eGFR, and higher serum phosphate level were independently associated with progression to commencement of dialysis or death. ConclusionsOur results show an independent association between baPWV and renal function decline and progression to commencement of dialysis or death in patients with CKD. Screening CKD patients by means of baPWV may help identify a high-risk group of rapid renal function decline and progression to commencing dialysis or death.

Cut-Off Value of Brachial-Ankle Pulse Wave Velocity to Predict Cardiovascular Disease in Hypertensive Patients: A Cohort Study

“…Thus, baPWV has gradually come into clinical use. Many studies have reported the association between baPWV and CVD [11][12][13][14][15] ; therefore, our results of the cut-off value of baPWV for predicting cardiovascular prognosis could extend the usefulness of baPWV to the management of hypertensive patients in clinical settings.…”

“…We can calculate baPWV easily and automatically using pressure cuffs on the brachial and tibial arteries. Many studies have investigated the clinical significance of baPWV 9,10) , which has been revealed to correlate significantly with coronary artery disease 11) , declined renal function 12) , and total mortality 13) . We previously reported the clinical usefulness and limitations of baPWV 14,15) , which has a close correlation with cfPWV 16) .…”

Brachial-ankle pulse wave velocity and brachial pre-ejection period to ejection time ratio with renal outcomes in chronic kidney disease

“…Blood pressure might also influence renal outcomes in CKD patients. 7 We statistically adjusted for mean arterial pressure in the multivariate analysis and still found that high baPWV and bPEP/bET was significantly associated with rapid renal progression and renal endpoints.…”

“…5,6 We recently evaluated the influence of baPWV, a marker of arterial stiffness, on renal function progression in a cohort of patients with moderate to advanced CKD and found that baPWV was independently associated with renal function decline and progression to commencing dialysis or death. 7 One possible mechanism is that increased arterial stiffness might result in greater transmission of elevated systemic blood pressure to the glomerular capillaries, thereby exacerbating glomerular hypertension, a major determinant of progressive renal damage. 19,20 Similarly, when comparing the two groups with high baPWV, only the group that also had high bPEP/bET was associated with adverse renal outcomes (vs. low baPWV and bPEP/bET).…”

“…3,4 Increased arterial stiffness is also reported to have a role in renal dysfunction progression. [5][6][7] A clinical device has been developed to automatically and simultaneously measure blood pressure in both arms and ankles, and record pulse waves of the brachial and posterior tibial arteries, using an automated oscillometric method. This device facilitates a simple measurement of brachial-ankle pulse wave velocity (baPWV) values, which are a good marker of arterial stiffness.…”