Central pulse pressure in chronic kidney disease: a chronic renal insufficiency cohort ancillary study

Abstract

Central pulse pressure (PP) can be noninvasively derived using the radial artery tonometric methods. Knowledge of central pressure profiles has predicted cardiovascular morbidity and mortality in several populations of patients, particularly those with known coronary artery disease and those receiving dialysis. Few data exist characterizing central pressure profiles in patients with mild-moderate chronic kidney disease who are not on dialysis. We measured central PP cross-sectionally in 2531 participants in the Chronic Renal Insufficiency Cohort Study to determine correlates of the magnitude of central PP in the setting of chronic kidney disease. Tertiles of central PP were <36 mm Hg, 36 to 51 mm Hg, and >51 mm Hg with an overall mean (+/-SD) of 46+/-19 mm Hg. Multivariable regression identified the following independent correlates of central PP: age, sex, diabetes mellitus, heart rate (negatively correlated), glycosylated hemoglobin, hemoglobin, glucose, and parathyroid hormone parathyroid hormone concentrations. Additional adjustment for brachial mean arterial pressure and brachial PP showed associations for age, sex, diabetes mellitus, weight, and heart rate. Discrete intervals of brachial PP stratification showed substantial overlap within the associated central PP values. The large size of this unique chronic kidney disease cohort provides an ideal situation to study the role of brachial and central pressure measurements in kidney disease progression and cardiovascular disease incidence.

Figure 1

Plot of Central Pulse Pressure in 5 mmHg increments along X-axis and number of participants in that increment on Y-axis. Green bars are all CRIC participants (n=2531). Yellow bars are those without (n=1343) and Ochre bars are those with (n=1188) diabetes.

Figure 2

Upper Left panel plots central pulse pressure in 10 mmHg increments among those with eGFR < 30 mL/min/1.73m2. Upper Right plots those with eGFR 30–44.9, Lower Left plots those with eGFR of 45–59.9 and the Lower Right panel depicts those with an eGFR > 60. Arrow onset marks Central Pulse Pressure (CPP) of 50 mmHg and percent (%) indicates the portion of participants within that eGFR range with a CPP > 50 mmHg.

Figure 3

shows discrete intervals of brachial pulse pressure in 10 mmHg increments on Y-axis and corresponding range of central pulse pressure measured on the X-axis. Box represents 25–75 percentile, whiskers indicate 95^th percentile, line inside box is median value.