Arterial stiffness and chronic kidney disease: lessons from the Chronic Renal Insufficiency Cohort study

Abstract

Purpose of review: The purpose of this review is to highlight what the Chronic Renal Insufficiency Cohort (CRIC) study has taught us regarding arterial stiffness in chronic kidney disease. The CRIC study began in mid-2003 and enrolled more than 3900 people with chronic kidney disease.

Recent findings: The recent findings from the CRIC study are covered in 10 lessons. Within the CRIC study, we enrolled about 2800 participants who underwent a pulse wave velocity measurement. At the time of initial funding, very little was known about the role of arterial stiffness in chronic, nondialyzed, kidney disease. The lessons span the gamut from simple correlations to measures such as central arterial pressure profiles and reproducibility of pulse wave velocity measurements between operators, to relationships of pulse wave velocity to kidney function, protein excretion, cardiovascular disease prevalence, and incident cardiovascular events such as heart failure.

Summary: The implications from these lessons are that pulse wave velocity is a robust, reproducible measure of arterial stiffness which adds important information to standard clinical assessments such as SBP and DBP in a population with chronic kidney disease, a disorder with high likelihood of progressive kidney function loss, and a substantial predisposition to cardiovascular disease.

FIGURE 1

Pulse wave velocity in meters/second in participants separated by decades of age, enrolled in the CRIC study, who did not have diabetes (left side, open bars) or did have diabetes (right side, black bars) with SD (error bars). On an average, pulse wave velocity is about 2 m/s faster, within any decade, when diabetes is present. Graphic re-drawn from published data in reference [14]. CRIC, Chronic Renal Insufficiency Cohort.

FIGURE 2

Pulse wave velocity in meters/second in participants separated by 10 ml/min/1.73 m² decrements in eGFR (left side, open bars) or by NKF stage (right side, black bars) with SD (error bars). Graphic re-drawn from published data in reference [14]. eGFR, estimated glomerular filtration rate; NKF, National Kidney Foundation.

FIGURE 3

Percentage of CRIC participants with a central pulse pressure above 50 mmHg separated by NKF stage, in which case stage 2 is an eGFR of 60 ml/min/1.73 m² and above, stage 3A is an eGFR of 45–59 ml/min/1.73 m², stage 3B is an eGFR of 30–44 ml/min/1.73 m², and stage 4 is an eGFR of below 30 ml/min/1.73 m². Values within bars show number of participants above central pulse pressure of 50 mmHg (numerator) versus total number of CRIC participants within that NKF stage (denominator). Graphic re-drawn from published data in reference [20]. CRIC, Chronic Renal Insufficiency Cohort; eGFR, estimated glomerular filtration rate; NKF, National Kidney Foundation.

FIGURE 4

New incident heart failure free event among CRIC participants initially free of heart failure by self-report. Heart failure event rates are per 100 person-years and separated by tertiles of PWV with the range of PWV for each tertile shown underneath the bar. Re-drawn from reference [22^▪▪]. CRIC, Chronic Renal Insufficiency Cohort; PWV, pulse wave velocity.

FIGURE 5

Representative cognitive function tests and quartiles of pulse wave velocity. Upper panel compares PWV quartiles with Z-scores in participants performing the Mini-Mental Status Exam (MMSE). Lower panel compares PWV quartiles with Z-scores in participants performing the trails B test. Graphic re-drawn from published abstract cited as reference [38]. PWV, pulse wave velocity.

FIGURE 6

Data presented at regional symposium (no published abstract available). Shown are percentages of CRIC participants with any cardiovascular disease (self-report) at baseline in CRIC separated by age categories of 21–44 years, 45–64 years, and above 64 years. The graphic is subdivided by tertiles of pulse wave velocity within each age category. CRIC, Chronic Renal Insufficiency Cohort; CVD, cardiovascular disease.