Abstract 16670: Significance of Cardio-Ankle Vascular Index as an Indicator of Renal Function Decline: A Systematic Review and Meta-Analysis

Abstract

Introduction: Large artery stiffness leads to increased pulsatile energy transmission to the microvasculature, resulting in microvascular damage in high-flow low-resistance organs, including the kidneys. Cardio-ankle vascular index (CAVI) is an index of arterial stiffness that is less blood pressure dependent. However, its association with renal function remains understudied. Hypothesis: To determine if baseline CAVI is associated with renal function decline. Methods: The databases PubMed, Scopus, and Web of Science were systematically searched until June 2023 for original longitudinal studies. The study outcome was defined as renal function decline or incidence/progression of chronic kidney disease. The “Methodological Index for Non-Randomized Studies” (MINORS) was used for quality assessment. Pooled effect measures were calculated with random-effects models that were stratified based on CAVI cutoffs and the reported effect measure. Results: Among 7 studies (66,595 subjects; 45% male) the ranges of average age, eGFR, and follow-up duration were 46-69 years, 51-87 mL/min/1.73m2, and 1-7 years, respectively. All but one study (Kusunose et al.) reported adjusted models. The meta-analyses showed significant associations between high baseline CAVI and worsening renal function outcomes among studies reporting hazard ratios for a categorical exposure (HR=1.30; 95% CI [1.18-1.43]; P<0.001; I 2 =38%), continuous exposure (HR [per SD] =1.14 [1.04-1.25]; P=004; I 2 =23%), and for odds ratios (OR [categorical exposure] =1.67 [1.01-2.76]; P=0.046; I 2 =71%). Conclusions: We observed a significant association between higher baseline CAVI and renal function decline over time. These results suggest that CAVI is a marker of kidney disease risk. Further research is warranted to investigate the role of CAVI as an indicator of risk of end-organ damage, and to investigate interventions targeting arterial stiffness to mitigate the burden of chronic kidney disease.