PS-C27-6: HIGH BRACHIAL-ANKLE PULSE WAVE VELOCITY IS ASSOCIATED WITH THE RENAL OUTCOME IN CHRONIC KIDNEY DISEASE PATIENTS WITH HYPERTENSION

Abstract

Background: Increase in arterial stiffness is associated with increase in cardiovascular events and mortality. Although studies have shown an association between arterial stiffness and chronic kidney disease (CKD), the association between CKD progression and arterial stiffness has not been clearly defined. The aim of this study is to investigate the association between brachial-ankle pulse wave velocity and chronic kidney disease progression in CKD patients with hypertension. Methods: A total of 717 CKD (stage 3 to 5) patients with hypertension were enrolled from the prospective observational cohort of CMERC-HI (Cardiovascular and Metabolic Disease Etiology Research Center-High Risk). Patients were classified into tertile based on brachial-ankle PWV: low, intermediate, high. Primary outcome was progression of CKD, which was composite of at least 50% decrease in estimated glomerular filtration rate (eGFR) from baseline or end stage kidney disease requiring dialysis. Results: The mean age of study subjects was 60.7 ± 11.8 years and 404 (56.3%) were male. During a median follow-up of 42.5 months, CKD progression occurred in 213 (29.7%). There were statistically significant differences in age (54.0 ± 12.1, 61.0 ± 11.1, 67.1 ± 8.2 in low, intermediate, high group, respectively, P < 0.001) among brachial-ankle PWV tertile groups. In multivariate Cox analysis, brachial-ankle PWV above the median value was related to increased risk of CKD progression (HR, 2.29; 95% CI, 1.33–3.94, P = 0.003) compared to subjects with brachial-ankle PWV below the median. In addition, when the study population was divided into tertiles, the intermediate and high brachial-ankle PWV group were associated with progressively increased risk of CKD progression (HR, 2.03; 95% CI, 1.09–3.77, P = 0.03, HR, 2.51: 95% CI, 1.27–4.96, P = 0.008) compared to low brachial-ankle PWV group after adjusting for confounding factors. The Kaplan-Meier analysis also showed statistically significant association between brachial-ankle PWV and CKD progression. In contrast, there was no statistically significant association between CKD progression and femoral-ankle PWV, an index for peripheral arterial stiffness, which suggests that increase in central arterial stiffness is associated with CKD progression. Conclusions: High brachial-ankle pulse wave velocity may be an independent predictor of CKD progression in CKD patients with hypertension.