Abstract
The Effect of a Reduction in GFR after Nephrectomy on Arterial Stiffness and Central Hemodynamics (EARNEST) study was a multicenter, prospective, controlled study designed to investigate the associations of an isolated reduction in kidney function on BP and arterial hemodynamics. Prospective living kidney donors and healthy controls who fulfilled criteria for donation were recruited from centers with expertise in vascular research. Participants underwent office and ambulatory BP measurement, assessment of arterial stiffness, and biochemical tests at baseline and 12 months. A total of 469 participants were recruited, and 306 (168 donors and 138 controls) were followed up at 12 months. In the donor group, mean eGFR was 27 ml/min per 1.73 m2 lower than baseline at 12 months. Compared with baseline, at 12 months the mean within-group difference in ambulatory day systolic BP in donors was 0.1 mm Hg (95% confidence interval, -1.7 to 1.9) and 0.6 mm Hg (95% confidence interval, -0.7 to 2.0) in controls. The between-group difference was -0.5 mm Hg (95% confidence interval, -2.8 to 1.7; P=0.62). The mean within-group difference in pulse wave velocity in donors was 0.3 m/s (95% confidence interval, 0.1 to 0.4) and 0.2 m/s (95% confidence interval, -0.0 to 0.4) in controls. The between-group difference was 0.1 m/s (95% confidence interval, -0.2 to 0.3; P=0.49). Changes in ambulatory peripheral BP and pulse wave velocity in kidney donors at 12 months after nephrectomy were small and not different from controls. NCT01769924 (https://clinicaltrials.gov/ct2/show/NCT01769924).
Highlights
CKD is a major risk factor for cardiovascular disease; there is a graded association, independent of multiple cardiovascular risk factors, between GFR and cardiovascular risk [1]
A total of 38 controls and 46 donors were patients who originally consented into the CRIB-DONOR substudy; these participants reconsented to allow their data to be included [26]
A total of 141 participants were unable to attend follow-up at 12 months, leaving 168 donors and 138 controls with complete paired data who were included in the final analysis
Summary
CKD is a major risk factor for cardiovascular disease; there is a graded association, independent of multiple cardiovascular risk factors, between GFR and cardiovascular risk [1]. In early stage CKD, mortality from cardiovascular events is more likely than the need for KRT [2]. In patients with ESKD, increased arterial stiffness as measured by pulse wave velocity is an independent predictor of mortality [4]. Increased arterial stiffness is highly prevalent in the earlier stages of CKD [5]. It is not clear whether increased BP and arterial stiffness in CKD are direct consequences of the reduced GFR or result from multiple comorbid conditions that tend to accompany CKD. Effect of a Reduction in GFR after Nephrectomy on Arterial Stiffness and Central Hemodynamics (EARNEST) study was a multicenter, prospective, controlled study designed to investigate the associations of an isolated reduction in kidney function on BP and arterial hemodynamics
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