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Arterial Stiffness in Mild-to-Moderate CKD

Ashish Upadhyay^*, Shih-Jen Hwang, Gary F. Mitchell, Ramachandran S. Vasan^,, Joseph A. Vita, Plamen I. Stantchev, James B. Meigs^||, Martin G. Larson^,¶, Daniel Levy, Emelia J. Benjamin^,,** and Caroline S. Fox^,

*Renal Section, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts;
National Heart, Lung and Blood Institute's Framingham Heart Study and the Center for Population Studies, Framingham, Massachusetts;
Cardiovascular Engineering Inc., Norwood, Massachusetts;
Cardiology Section and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts;
^||Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts;
^¶Department of Mathematics and Statistics, Boston University, Boston, Massachusetts;
**Boston University School of Public Health, Boston, Massachusetts;
Division of Endocrinology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts

Correspondence: Dr. Caroline S. Fox, National Heart, Lung and Blood Institute's Framingham Heart Study, 73 Mount Wayte Avenue, Suite #2, Framingham, MA 01702, Phone: +508-935-3447; Fax: +508-626-1262; E-mail: foxca{at}nhlbi.nih.gov

Received for publication January 19, 2009. Accepted for publication May 21, 2009.

Whether arterial stiffness correlates with mild-to-moderate CKD and albuminuria in the community is unclear. We studied the association between arterial stiffness and mild-to-moderate CKD and albuminuria in the Framingham Heart Study. CKD was present in 6.7% (181 of 2682) of participants and microalbuminuria was present in 8.2% (479 of 5818). The measures of arterial stiffness were the carotid femoral pulse wave velocity, forward pressure wave amplitude, central pulse pressure, augmentation pressure, augmentation index, and mean arterial pressure. In cross-sectional analyses, arterial stiffness did not associate with CKD (defined by estimated GFR <60 ml/min/1.73 m²) in either age- and gender-adjusted or multivariable-adjusted linear regression models. Carotid femoral pulse wave velocity associated with both urinary albumin-to-creatinine ratio and microalbuminuria (P < 0.0001 after multivariable adjustment). In longitudinal analyses, we used logistic regression models to examine the associations between baseline arterial stiffness measures (exposure variables) and incident CKD or microalbuminuria (n = 1675 for CKD analyses and n = 1252 for microalbuminuria analyses). Baseline arterial measures did not associate with incident CKD or incident microalbuminuria. In summary, arterial stiffness correlates with albuminuria but not with mild-to-moderate CKD.

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Copyright © 2009 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673