Brachial-Ankle Pulse Wave Velocity is Associated with Kidney Function Decline in Adults Undergoing Cardiovascular Disease Screening.

Abstract

Background: CKD affects 35 million adults in the US and is associated with high morbidity and mortality. We investigated whether brachial-ankle pulse wave velocity (baPWV), a non-invasive measure of arterial stiffness, was associated with kidney function decline in adults undergoing cardiovascular disease (CVD) screening.

Methods: In 1,862 patients referred for an exercise ECG test between 2007-2009, baPWV was measured using an Omron Colin oscillometric device. Creatinine-based GFR was estimated (eGFRCr) for participants with available baseline and follow-up creatinine values using the CKD-EPI formula. We performed multivariable linear regression analyses to assess whether baseline baPWV was associated with annualized change in eGFRCr (∆ eGFRCr), after adjustment for age, sex, body mass index (BMI), baseline eGFRCr, and traditional CVD risk factors, including mean arterial pressure (MAP), diabetes and hypertension diagnoses, nephroprotective medication use, smoking status, and total cholesterol. To determine risk of developing CKD and CKD-free survival time by arterial stiffness subgroups, we performed covariable-adjusted Cox proportional hazards modeling and a Kaplan-Meier survival analysis, respectively.

Results: After exclusion of participants with missing covariable data and adjustment for covariables, one standard deviation increase in baPWV was associated with a 0.18 mL/min/1.73 m2 BSA greater yearly decrease in eGFRCr (P=0.023) over a median follow-up time of 13.2 years. Participants with higher baseline baPWV had increased risk of CKD (HR (95% CI), P-value; elevated baPWV: 2.4 (1.1, 5.4), P=0.037; borderline-elevated baPWV: 1.8 (1.1, 3.1), P =0.028) and had a shorter CKD-free survival time (median CKD-free survival time (years); normal baPWV: 16.2; borderline-elevated baPWV: 16.0; elevated baPWV: 15.6 (P<0.001)).

Conclusions: Elevated baPWV, a noninvasive measure of arterial stiffness that can be obtained in the office setting, was associated with decline in kidney function, risk of CKD development, and CKD-free survival in individuals undergoing CVD screening.