Brachial-ankle pulse wave velocity and brachial pre-ejection period to ejection time ratio with renal outcomes in chronic kidney disease

Abstract

Heart failure and increased arterial stiffness are associated with declining renal function. This longitudinal study was designed to assess whether the combination of brachial-ankle pulse wave velocity (baPWV) and the ratio of brachial pre-ejection period (bPEP) to brachial ejection time (bET) was independently associated with renal outcomes in patients with chronic kidney disease (CKD), stages 3-5. The baPWV and bPEP/bET values were measured using an ankle-brachial index (ABI)-form device in 186 patients who were classified into 4 groups according to the baPWV and bPEP/bET median values. Renal function change was determined by estimated glomerular filtration rate (eGFR) slope. Rapid renal progression was defined as an eGFR slope less than -3 ml min(-1) per 1.73 m(2) per year. The renal endpoints were defined as commencement of dialysis or 25% decline in eGFR. Among the four study groups, the group with high baPWV and bPEP/bET values had the lowest eGFR slope (P0.042). Multivariate analysis revealed that this group was independently associated with rapid renal progression (odds ratio, 9.560; P=0.009) and progression to renal endpoints (hazard ratio, 2.587; P=0.039). Our findings show that a combination of high baPWV and bPEP/bET is associated with adverse renal outcomes in patients with advanced CKD. Screening CKD patients by baPWV and bPEP/bET during the same examination may help identify patients with an elevated risk for adverse renal outcomes.