Arterial Stiffness and Decline in Kidney Function

Abstract

Background and objectives: The independent link between arterial stiffness and CKD remains unknown. We investigated the association of indicators of arterial stiffness with decline in kidney function.

Design, setting, participants, & measurements: We studied 3666 participants (mean age =65 years old; 58% women) from the Rotterdam Study. Pulse pressure (PP), carotid stiffness, and pulse wave velocity (PWV) were measured. We created genetic risk scores for PP and PWV. Annual declines in kidney function and incident CKD were assessed using eGFR. To put our findings in context of the literature, we performed a meta-analysis of the available population-based studies.

Results: After a median (interquartile range) follow-up time of 11 (10.7-11.3) years, 601 participants with incident CKD were recognized. In the model adjusted for age, sex, mean arterial pressure, heart rate, and baseline GFR, each SD higher PP was associated with 0.15-ml/min per 1.73 m(2) steeper annual eGFR decline (95% confidence interval [95% CI], 0.10 to 0.20) and 11% higher risk of incident CKD (95% CI, 1.05 to 1.18). Each SD greater carotid stiffness was associated with 0.08-ml/min per 1.73 m(2) steeper annual eGFR decline (95% CI, 0.04 to 0.13) and 13% higher risk of incident CKD (95% CI, 1.05 to 1.22). Each SD higher PWV was associated with 7% higher risk of incident CKD (95% CI, 1.00 to 1.14). Incorporating our findings in a meta-analysis, each SD higher PP and PWV were associated with 16% (95% CI, 1.12 to 1.21) and 8% (95% CI, 1.03 to 1.14) higher risks of incident CKD. Each SD higher PP genetic risk score was associated with 0.06-ml/min per 1.73 m(2) steeper annual eGFR decline (95% CI, 0.01 to 0.10) and 8% higher risk of incident CKD (95% CI, 1.03 to 1.14). There was no association between PWV genetic risk score and kidney function decline.

Conclusions: Higher indices of arterial stiffness are associated with steeper decline in kidney function. This suggests that vascular stiffness could be considered as a target for delaying decline in kidney function.

Keywords: arterial stiffness; blood pressure; carotid stiffness; chronic kidney disease; follow-up studies; genetic risk score; meta-analysis; pulse pressure; pulse wave analysis; vascular stiffness.

Figure 1.

Linear association between arterial stiffness measures and their corresponding genetic risk scores. (A) Mean and SEM of pulse pressure in tertiles of pulse pressure genetic risk score. (B) Mean and SEM of pulse wave velocity in tertiles of pulse wave velocity genetic risk score. Analyses are adjusted for age and sex. 95% CI, 95% confidence interval.

Figure 2.

Higher pulse pressure and pulse wave velocity are associated with higher risk of incident CKD. Forest plots of multivariate–adjusted relative risks (RRs) for the association of each SD of (A) pulse pressure and (B) pulse wave velocity with incident CKD (11). Health ABC, health, aging, and body composition; 95% CI, 95% confidence interval.