Determinants of Peripheral Arterial Stiffness in Patients With Chronic Kidney Disease in Southern Taiwan

Chen, Jui-Hsin; Chen, Szu-Chia; Liu, Wanchun; Su, Ho‐Ming; Chen, Chiu-Yueh; Mai, Hsiu-Chin; Chou, Ming-Chin; Chang, Jer‐Ming

doi:10.1016/s1607-551x(09)70529-7

Cited by 21 publications

(25 citation statements)

References 32 publications

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“…Increased arterial stiffness was reported to be associated with decreased eGFR in cross-sectional studies. 19 Three longitudinal studies using different measurement methods of arterial stiffness (that is, augmentation index, radial-dorsalis pedis PWVs and aortic PWVs) showed that increased arterial stiffness was an independent predictor of renal function progression in patients with chronic kidney disease. [5][6][7] They explained their finding citing the greater transmission of elevated systemic blood pressure to the glomerular capillaries, thereby exacerbating glomerular hypertension caused by increased arterial stiffness.…”

Section: Discussionmentioning

confidence: 99%

Impaired left ventricular systolic function and increased brachial-ankle pulse-wave velocity are independently associated with rapid renal function progression

et al. 2011

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Heart failure and increased arterial stiffness are associated with declining renal function. Few studies have evaluated the association between left ventricular ejection fraction (LVEF) and brachial-ankle pulse-wave velocity (baPWV) and renal function progression. The aim of this study was to assess whether LVEFo40% and baPWV are associated with a decline in the estimated glomerular filtration rate (eGFR) and the progression to a renal end point of X25% decline in eGFR. This longitudinal study included 167 patients. The baPWV was measured with an ankle-brachial index-form device. The change in renal function was estimated by eGFR slope. The renal end point was defined as X25% decline in eGFR. Clinical and echocardiographic parameters were compared and analyzed. After a multivariate analysis, serum hematocrit was positively associated with eGFR slope, and diabetes mellitus, baPWV (P¼0.031) and LVEFo40% (P¼0.001) were negatively associated with eGFR slope. Forty patients reached the renal end point. Multivariate, forward Cox regression analysis found that lower serum albumin and hematocrit levels, higher triglyceride levels, higher baPWV (P¼0.039) and LVEFo40% (Po0.001) were independently associated with progression to the renal end point. Our results show that LVEFo40% and increased baPWV are independently associated with renal function decline and progression to the renal end point.

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Section: Discussionmentioning

confidence: 99%

Impaired left ventricular systolic function and increased brachial-ankle pulse-wave velocity are independently associated with rapid renal function progression

et al. 2011

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“…The ABI and brachial-ankle PWV were measured using an ABI-form device, which automatically and simultaneously measured BPs in both arms and ankles using an oscillometric method (10)(11)(12)(13)(14)(15)(16). Occlusion and monitoring cuffs were placed tightly around the upper arm without blood access and both sides of the lower extremities in the supine position.…”

Section: Assessment Of Abi and Brachial-ankle Pulse Wave Velocitymentioning

confidence: 99%

“…The ABI and brachial-ankle PWV measurements were done once in each patient. Because the ABI and brachial-ankle PWV were noninvasive and reliable diagnostic tools for peripheral vascular disease (11,13), patients with ABI ,0.9 or increased brachial-ankle PWV were considered to have peripheral vascular disease in this study.…”

Section: Assessment Of Abi and Brachial-ankle Pulse Wave Velocitymentioning

confidence: 99%

Association of Interleg BP Difference with Overall and Cardiovascular Mortality in Hemodialysis

Chen

Chang

Tsai

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives An interarm BP difference has been associated with atherosclerosis and adverse cardiovascular outcomes. This study investigated whether an interleg BP difference was associated with peripheral vascular disease and overall and cardiovascular mortality in hemodialysis patients. Results The mean follow-up period was 4.461.5 years. ABI ,0.9 and high brachial-ankle pulse wave velocity were independently associated with an interleg difference in systolic BP of $15 mmHg or diastolic BP of $10 mmHg. Furthermore, this difference was an independent predictor for overall mortality (hazard ratio [HR], 3.36; 95% confidence interval [CI], 1.68-6.72; P,0.01) and cardiovascular mortality (HR, 4.84; 95% CI, 1.84-12.71; P,0.01) after adjustment for demographic, clinical, and biochemical parameters. After further adjustment for ABI ,0.9 and brachial-ankle pulse wave velocity, the relation remained significant to overall mortality (HR, 2.91; 95% CI, 1.28-6.64; P=0.01) and cardiovascular mortality (HR, 3.15; 95% CI, 1.05-9.44; P=0.04).Conclusions A difference in systolic BP of $15 mmHg or diastolic BP of $10 mmHg between legs was associated with peripheral vascular disease and increased risk for overall and cardiovascular mortality in hemodialysis patients. Detection of an interleg BP difference may identify hemodialysis patients at increased risk of peripheral vascular disease and overall and cardiovascular mortality.

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“…Increased arterial stiffness may be responsible for cardiovascular burden in the CKD population (3,4). Previous studies have reported the association between decreased estimated GFR (eGFR) and increased arterial stiffness (5)(6)(7). Decreased eGFR may predispose to increased arterial stiffness with multiple pathogenic mechanisms involved, including deranged calcium/phosphate balance, secondary hyperparathyroidism, homocysteine, lipoprotein(a) metabolism, fluid overload, alterations in the angiotensin and endothelin systems, malnutrition, uremic toxins, oxidative stress, insulin resistance, and alterations in inflammatory and coagulation pathways (8,9).…”

Section: Introductionmentioning

confidence: 99%

Brachial-Ankle Pulse Wave Velocity and Rate of Renal Function Decline and Mortality in Chronic Kidney Disease

Chen

Chang²,

Liu³

et al. 2011

Clinical Journal of the American Society of Nephrology

104

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SummaryBackground and objectives Increased arterial stiffness was reported to be associated with decreased estimated GFR (eGFR). Previous studies suggested that arterial stiffness might play a role in renal function progression in patients with chronic kidney disease (CKD). The aim of this study was to investigate whether there was an independent association between brachial-ankle pulse wave velocity (baPWV), a marker of arterial stiffness, and renal function progression in CKD patients.Design, setting, participants, & measurements This longitudinal study enrolled 145 patients with CKD stages 3 to 5. The baPWV was measured by using an ABI-form device. The change in renal function was estimated by eGFR slope. The study endpoints were defined as commencement of dialysis or death.Results After a stepwise multivariate analysis, the eGFR slope was positively associated with baseline eGFR and negatively associated with hypertension and baPWV (␤ ϭ Ϫ0.165, P ϭ 0.033). Seventeen patients entering dialysis, and eight deaths were recorded. Multivariate forward Cox regression analysis identified that higher baPWV (hazard ratio, 1.001; P ϭ 0.001), lower baseline eGFR, and higher serum phosphate level were independently associated with progression to commencement of dialysis or death. ConclusionsOur results show an independent association between baPWV and renal function decline and progression to commencement of dialysis or death in patients with CKD. Screening CKD patients by means of baPWV may help identify a high-risk group of rapid renal function decline and progression to commencing dialysis or death.

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Determinants of Peripheral Arterial Stiffness in Patients With Chronic Kidney Disease in Southern Taiwan

Cited by 21 publications

References 32 publications

Impaired left ventricular systolic function and increased brachial-ankle pulse-wave velocity are independently associated with rapid renal function progression

Impaired left ventricular systolic function and increased brachial-ankle pulse-wave velocity are independently associated with rapid renal function progression

Association of Interleg BP Difference with Overall and Cardiovascular Mortality in Hemodialysis

Brachial-Ankle Pulse Wave Velocity and Rate of Renal Function Decline and Mortality in Chronic Kidney Disease

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