Time for Reflection Predicts the Progression of Renal Dysfunction in Patients with Nondiabetic Chronic Kidney Disease

Abstract

Our previous data indicated that both home blood pressure and arterial stiffness predicted the progression of renal dysfunction in the patients with chronic kidney diseases. In the present study, we examined both home blood pressure and the parameters of arterial stiffness as the indicator to the progression of chronic kidney diseases. Forty-two nondiabetic chronic kidney disease patients were enrolled and followed for 1 year. Anti-hypertensive therapy was adjusted to achieve office blood pressure below 130/80 mmHg. Home blood pressure was examined twice a day in the morning and evening. Pulse wave velocity (PWV) and augmentation index (AI) were measured as the index of arterial stiffness. The time for reflection (TR) was also determined. The relationship of annual changes in serum creatinine (Scr) with the above parameters was assessed. Multivariate regression analysis revealed that TR inversely correlated to annual increase in Scr (beta = -0.03, p < 0.05). Home blood pressure did not correlate to annual changes in Scr in the present study. The present data indicated that arterial stiffness is elevated despite good blood pressure control in chronic kidney disease, especially among the dippings. In addition, our data suggest that PWV and AI correlated to each other, while they were influenced differently by hemodynamic factors. Finally, the present findings provide the evidence that the arterial stiffness parameter is more sensitive than home blood pressure as an indicator to the progression of chronic kidney disease.

Paradoxical Distribution of Augmentation Index Level in Chronic Kidney Diseases

“…6 Thus, time for reflection should be shorter in advanced CKD. 5 In contrast, in the present study, patients with CKD stage 5 showed lower AI than CKD stage 1. The present data do not help to clarify the mechanisms mediating lower AI in CKD stage 5.…”

“…14 However, PWV and AI correlated to each other in stage 1-3 of non-diabetic CKD patients. 5 The presence of diabetes tends to decrease AI ( Table 2). The prevalence of diabetes may underlie the difference between the 2 studies.…”

“…4 We have previously demonstrated that PWV correlated to AI in stage 1-3 non-diabetic chronic kidney disease (CKD) patients. 5 PWV is known to rise as the stage of CKD advances. 6 However, we are not aware of any data being available that examines whether AI rises as CKD progresses.…”

Serum phosphate but not pulse wave velocity predicts decline in renal function in patients with early chronic kidney disease

“…Studying a cohort of patients with advanced CKD and the unorthodox use of radial-dorsalis pedis PWV rather than the gold standard carotid-femoral PWV may explain this difference. In a Jap-anese study of only 41 subjects with non-diabetic CKD, AIx predicted a greater decline in renal function [39], although a subsequent study by this group of 42 patients failed to replicate this finding [40]. A third study of 133 patients with Stage III-IV CKD showed PWV predicted decline in renal function [24].…”

The natural history of, and risk factors for, progressive Chronic Kidney Disease (CKD): the Renal Impairment in Secondary care (RIISC) study; rationale and protocol

“…In a Japanese study of 41 subjects with non-diabetic CKD AIx predicted a greater decline in renal function [95]. Interestingly, a subsequent study by this group in 42 patients failed to replicate this finding and did not demonstrate any relationship between PWV or AIx and progression of renal dysfunction [96]. A third study of 133 patients with stage III-IV CKD showed PWV to be a predictor of decline in renal function [97].…”