Arterial Stiffness, Central Pressures, and Incident Hospitalized Heart Failure in the Chronic Renal Insufficiency Cohort Study

Chirinos, Julio A.; Khan, Abigail; Bansal, Nisha; Dries, Daniel L.; Feldman, Harold I.; Ford, Virginia; Anderson, Amanda H.; Kallem, Radhakrishna R.; Lash, James P.; Ojo, Akinlolu; Schreiber, Martin J.; Sheridan, Angela; Strelsin, Jillian; Teal, Valerie; Roy, Jason; Pan, Qiang; Go, Alan S.; Townsend, Raymond R.

doi:10.1161/circheartfailure.113.001041

Cited by 86 publications

(72 citation statements)

References 48 publications

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“…30 Among CRIC Study participants, elevated pulse wave velocity, also a measure of large artery stiffening similar to PP, was strongly associated with incident HF. 35 …”

Section: Discussionmentioning

confidence: 99%

Different components of blood pressure are associated with increased risk of atherosclerotic cardiovascular disease versus heart failure in advanced chronic kidney disease

Bansal

McCulloch

Lin

et al. 2016

Kidney International

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Blood pressure is a modifiable risk for cardiovascular disease (CVD). Among hemodialysis patients, there is a U-shaped association between blood pressure and risk of death. However, few studies have examined the association between blood pressure and CVD in patients with stage 4 and 5 chronic kidney disease. Here we studied 1,795 Chronic Renal Insufficiency Cohort (CRIC) Study participants with estimated glomerular filtration rate under 30 ml/min/1.73 m2 and not on dialysis. The association of systolic (SBP), diastolic (DBP) and pulse pressure with risk of physician-adjudicated atherosclerotic CVD (stroke, myocardial infarction or peripheral arterial disease) and heart failure were tested using Cox regression adjusted for demographics, comorbidity and medications. There was a significant association with higher SBP (adjusted hazard ratio 2.04 [95% confidence interval: 1.46, 2.84]) for SBP over 140 vs under 120 mmHg, higher DBP (2.52 [1.54, 4.11]) for DBP over 90 vs under 80 mmHg and higher pulse pressure (2.67 [1.82, 3.92]) for pulse pressure over 68 vs under 51 mmHg with atherosclerotic CVD. For heart failure, there was a significant association with higher pulse pressure only (1.42 [1.05, 1.92]) for pulse pressure over 68 vs under 51 mmHg, but not for SBP or DBP. Thus, among participants with stage 4 and 5 chronic kidney disease, there was an independent association between higher SBP, DBP and pulse pressure with risk of atherosclerotic CVD, while only higher pulse pressure was independently associated with greater risk of heart failure. Further trials are needed to determine whether aggressive reduction of blood pressure reduces the risk of CVD events in patients with stage 4 and 5 chronic kidney disease.

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“…30 Among CRIC Study participants, elevated pulse wave velocity, also a measure of large artery stiffening similar to PP, was strongly associated with incident HF. 35 …”

Section: Discussionmentioning

confidence: 99%

Different components of blood pressure are associated with increased risk of atherosclerotic cardiovascular disease versus heart failure in advanced chronic kidney disease

Bansal

McCulloch

Lin

et al. 2016

Kidney International

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“…Among CRIC participants, eGFR was inversely associated with PWV (29). Further, increased PWV was independently associated with a greater risk of hospitalization for incident HF (30).…”

Section: Aortic Stiffnessmentioning

confidence: 92%

Chronic Renal Insufficiency Cohort Study (CRIC)

Denker¹,

Boyle²,

Anderson³

et al. 2015

Clinical Journal of the American Society of Nephrology

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104

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The Chronic Renal Insufficiency Cohort (CRIC) Study is a United States multicenter, prospective study of racially and ethnically diverse patients with CKD. Although the original aims of the study were to identify novel predictors of CKD progression and to elucidate the risk and manifestations of cardiovascular disease among nearly 4000 individuals with CKD, the CRIC Study has evolved into a national resource for investigation of a broad spectrum of CKD-related topics. The study has produced >90 published scientific articles, promoted many young investigative careers in nephrology, and fostered international collaborations focused on understanding the global burden of CKD. The third phase of the CRIC Study will complete enrollment of 1500 additional study participants in 2015 and is designed to answer questions regarding morbidity and mortality in mild-to-moderate CKD and to assess the burden of CKD in older persons. This review highlights some of the salient findings of the CRIC Study in the areas of race and ethnicity, CKD progression, CKD and cognition, and cardiovascular disease outcomes; it also outlines the ongoing and forthcoming opportunities for the global nephrology community to enhance its understanding of CKD and related complications through the study.

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“…Interestingly, the net reclassification improvement index was significant, meaning that measuring carotid-femoral PWV in CKD patients improves the prediction of risk beyond classical CV risk factors [17]. An association between aortic stiffness and CV events was also seen in the CRIC study [18]. …”

Section: Impact Of Aortic Stiffness On CV and General Prognosismentioning

confidence: 99%

“…If the majority of the clinical studies are consistent with the observation that large artery damage may contribute to the high incidence of CV diseases [15,16,17,18], the impact of large artery remodeling on CKD progression is still a matter of debate. In the present review, we will describe the large artery remodeling observed in CKD and its impact on renal, CV and general prognosis (table 2).…”

Section: Introductionmentioning

confidence: 99%

Arterial Stiffness and Chronic Kidney Disease

Garnier

Briet²

2015

Pulse

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Chronic kidney disease (CKD) is a major public health concern due to the high prevalence of associated cardiovascular (CV) disease. CV mortality is 10-30 times higher in end-stage renal disease patients than in the age-adjusted general population. The last 20 years have been marked by a huge effort in the characterization of the vascular remodeling process associated with CKD and its consequences on the renal, CV and general prognosis. By comparison with patients with normal renal function, with or without hypertension, an increase in large artery stiffness has been described in end-stage renal disease as well as in CKD stages 2-5. Most clinical studies are consistent with the observation that damage to large arteries may contribute to the high incidence of CV disease. By contrast, the impact of large artery stiffening and remodeling on CKD progression is still a matter of debate. Concomitant exposure to other CV risk factors, including diabetes, seems to play a major role in the association between aortic stiffness and estimated GFR. The conflicting results obtained from longitudinal studies designed to evaluate the impact of baseline aortic stiffness on GFR progression are detailed in the present review. Only pulse pressure, central and peripheral, is almost constantly associated with incident CKD and GFR decline. Kidney transplantation improves patients' CV prognosis, but its impact on arterial stiffness is still controversial. Donor age, living kidney donation and mean blood pressure appear to be the main determinants of improvement in aortic stiffness after kidney transplantation.

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Arterial Stiffness, Central Pressures, and Incident Hospitalized Heart Failure in the Chronic Renal Insufficiency Cohort Study

Cited by 86 publications

References 48 publications

Different components of blood pressure are associated with increased risk of atherosclerotic cardiovascular disease versus heart failure in advanced chronic kidney disease

Different components of blood pressure are associated with increased risk of atherosclerotic cardiovascular disease versus heart failure in advanced chronic kidney disease

Chronic Renal Insufficiency Cohort Study (CRIC)

Arterial Stiffness and Chronic Kidney Disease

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