Abstract
BackgroundPulse wave velocity (PWV), central pulse pressure and augmentation index are arterial stiffness- related hemodynamic parameters but their associations with renal outcome are still controversial. We hereby aim to study, 1) which hemodynamic parameter is independently associated with progressive chronic kidney disease (CKD), 2) the association of 3-year change in PWV with CKD progression and, 3) the additive predictive value of PWV for progressive CKD.MethodsCarotid- femoral PWV, central pulse pressure and augmentation index were measured in 1444 participants with type 2 diabetes at baseline and 3 years apart. Progressive CKD was defined as confirmed eGFR decline 40% or greater.ResultsIn the follow-up, 102 participants experienced progressive CKD. All 3 hemodynamic parameters were significantly associated with progressive CKD In univariable analysis. However, only PWV remained statistically significant after adjustment for known clinical risk factors and the other 2 hemodynamic parameters (OR 1.14 [95% CI 1.01–1.29] per m/s increment). One m/s regression (decrement) in PWV in the 3-year follow-up was associated with 26% lower adjusted- risk of progressive CKD (OR 0.74, 95% CI 0.56–0.97). Adding PWV onto traditional risk factor- based model significantly improved classification (net reclassification improvement 0.25, 95% CI 0.05–0.45, P = 0.01) and positive prediction rate (24.5 to 32.3%).ConclusionsOf 3 arterial stiffness- related hemodynamic parameters, only PWV is independently associated with progressive CKD. PWV may be a potential intervention target to mitigate risk of CKD progression and also a biomarker to improve risk-stratification of adverse renal outcome in individuals with type 2 diabetes.
Highlights
Pulse wave velocity (PWV), central pulse pressure and augmentation index are arterial stiffnessrelated hemodynamic parameters but their associations with renal outcome are still controversial
It is the leading cause of end stage renal disease in developed countries and an independent risk factor for cardiovascular disease and mortality [1, 2]. Both metabolic risk factors and hemodynamic dysregulations are involved in the development and progression of chronic kidney disease (CKD) in patients with diabetes [3]
We aim to study, 1) which of the 3 hemodynamic parameters, i.e. pulse wave velocity (PWV), central pulse pressure and augmentation index, has the strongest association with progressive CKD; 2) whether the 3- year change in PWV is associated with risk of CKD progression; 3) the additive value of PWV as a biomarker for prediction of progressive CKD above traditional clinical risk factors in individuals with type 2 diabetes
Summary
Pulse wave velocity (PWV), central pulse pressure and augmentation index are arterial stiffnessrelated hemodynamic parameters but their associations with renal outcome are still controversial. Diabetic kidney disease affects more than 30% of patients with type 2 diabetes It is the leading cause of end stage renal disease in developed countries and an independent risk factor for cardiovascular disease and mortality [1, 2]. An early study found that central pulse pressure, but not PWV, was associated with progression to end stage renal disease in patients with CKD [12]. Whether this finding can be observed in diabetic population with a broad spectrum of kidney function remains unknown. The interrelationship of aortic PWV, central pulse pressure and augmentation index have not been characterized and the strength of their associations with renal outcomes as compared to one another has not been studied
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