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.
Bibliographical noteFunding Information:
Support: This research was supported by contracts N01-HC-95159 through N01-HC-95169 from the National Heart, Lung, and Blood Institute and by the National Institute of Diabetes and Digestive and Kidney Disease (grant 1K23DK082793-01 , Dr Peralta). These funding sources had no involvement in the design or execution of this study.
- Kidney function
- arterial elasticity
- chronic kidney disease