Association of pulse pressure, arterial elasticity, and endothelial function with kidney function decline among adults with estimated GFR >60 mL/min/1.73 m 2: The multi-ethnic study of atherosclerosis (MESA)

Carmen A. Peralta, David R. Jacobs, Ronit Katz, Joachim H. Ix, Magdalena Madero, Daniel A. Duprez, Mark J. Sarnak, Michael H. Criqui, Holly J. Kramer, Walter Palmas, David Herrington, Michael G. Shlipak

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Abstract

The association of subclinical vascular disease and early declines in kidney function has not been well studied. Prospective cohort study. Multi-Ethnic Study of Atherosclerosis (MESA) participants with estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m 2 with follow-up of 5 years. Pulse pressure, small (SAE) and large arterial elasticity (LAE), and flow-mediated dilation. Kidney function decline. SAE and LAE were measured by pulse contour analysis of the radial artery. Kidney function was assessed by eGFR based on serum creatinine (eGFR SCr) and cystatin C (eGFR SCysC). For 4,853 adults, higher pulse pressure and lower SAE and LAE had independent and linear associations with faster rates of kidney function decline. Compared with persons with pulse pressure of 40-50 mm Hg, eGFR SCysC declines were 0.29 (P = 0.006), 0.56 (P < 0.001), and 0.91 (P < 0.001) mL/min/1.73 m 2/y faster in persons with pulse pressure of 50-60, 60-70, and >70 mm Hg, respectively. Compared with the highest quartile of SAE (most elastic), eGFR SCysC declines were 0.26 (P = 0.009), 0.35 (P = 0.001), and 0.70 (P < 0.001) mL/min/1.73 m 2/y faster for the second, third, and fourth quartiles, respectively. For LAE, compared with the highest quartile, eGFR SCysC declines were 0.28 (P = 0.004), 0.58 (P < 0.001), and 0.83 (P < 0.001) mL/min/1.73 m 2/y faster for each decreasing quartile of LAE. Findings were similar for eGFR SCr. In contrast, for 2,997 adults with flow-mediated dilation and kidney function measures, flow-mediated dilation was not associated significantly with kidney function decline. For every 1standard deviation greater flow-mediated dilation, eGFR SCysC and eGFR SCr changed by 0.05 (P = 0.3) and 0.06 mL/min/1.73 m 2/y (P = 0.04), respectively. We had no direct measure of GFR, in common with nearly all large population-based studies. Higher pulse pressure and lower arterial elasticity, but not flow-mediated dilation, were associated linearly and independently with faster kidney function decline in persons with eGFR <60 mL/min/1.73 m 2. Future studies should investigate whether treatments to decrease the stiffness of large and small arteries may slow the rate of kidney function loss.

Original languageEnglish (US)
Pages (from-to)41-49
Number of pages9
JournalAmerican Journal of Kidney Diseases
Volume59
Issue number1
DOIs
StatePublished - Jan 2012

Keywords

  • Kidney function
  • arterial elasticity
  • atherosclerosis
  • chronic kidney disease

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