Relationship between arterial stiffness and chronic kidney disease in patients with hypertension

Objective. Previous studies have shown an association between arterial stiffness and kidney disease. Arterial stiffness, as measured by carotid-femoral pulse wave velocity (cfPWV) has been shown to be a strong prognostic marker in end-stage renal disease. This study aimed to investigate the association of noninvasive indices of arterial stiffness with chronic kidney disease (CKD) in patients with hypertension. Methods. Hypertensive hospital inpatients (n=574, mean age 60±10 years, 344 males) were recruited for this study, comprising 337 hypertensive patients without CKD and 210 hypertensive patients with CKD. We measured noninvasive arterial stiffness indices including central arterial haemodynamics using pulse wave analysis (SphygmoCor, AtCor Medical, Sydney) cfPWV (Complior SPIV, France), large and small artery elasticity indices (C1, C2 respectively) (CVProfilor, HDI, USA) and intima-media thickness (IMT) evaluated by ultrasonography (HD11EX, Philips Medical Systems). The diagnosis of CKD was assessed by the estimated glomerular filtration rate (eGFR) or urinary albumin creatinine ratio (ACR). Results. Compared to hypertensive patients without CKD, hypertensive patients with CKD were older, had higher central aortic blood pressure, cfPWV and IMT（all, p<0.01). With decreasing eGFR, cfPWV and augmentation index adjusted to heart rate of 75 bpm increased progressively whereas C2 decreased (p < 0.05) in subjects with CKD. C1 and C2 were negatively associated with log (ACR). In the overall population, after adjusting for age, gender and brachial systolic blood pressure, only cfPWV was negatively associated with eGFR (r = -0.092, p = 0.04). Multiple logistic analysis showed that 1 SD (3 m/s) increase in cfPWV entailed a 1.35 times higher risk of CKD organ damage after adjustment for various confounding factors. Conclusion. Of all the noninvasive indices of arterial stiffness measured in this study, cfPWV has been found to have an independent association with CKD in patients with hypertension. cfPWV may be a potential index to evaluate the risk of CKD in primary hypertension.