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. 2017 Apr 1;32(4):677-684.
doi: 10.1093/ndt/gfw050.

Aortic stiffness and change in glomerular filtration rate and albuminuria in older people

Naya Huang  1 , Meredith C Foster  2 , Gary F Mitchell  3 , Margret B Andresdottir  4 , Gudny Eiriksdottir  5 , Hrefna Gudmundsdottir  4   6 , Tamara B Harris  7 , Lenore J Launer  7 , Runolfur Palsson  4   6 , Vilmundur Gudnason  5   6 , Andrew S Levey  2 , Lesley A Inker  2
Affiliations

Aortic stiffness and change in glomerular filtration rate and albuminuria in older people

Naya Huang et al. Nephrol Dial Transplant. .

Abstract

Background: Aortic stiffness increases with age and increases pulsatile stress in the microcirculation. Abnormalities in kidney microvascular structure and function may contribute to development or progression of chronic kidney disease in older people.

Methods: We performed a longitudinal analysis of 629 community-dwelling elderly Icelandic adults from the Age, Gene/Environment Susceptibility-Reykjavik Study with two visits over a mean follow-up of 5.3 years. We evaluated the associations of carotid-femoral pulse wave velocity (CFPWV), carotid pulse pressure (CPP) and augmentation index (AI), with the change in estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) assessed as annual change and dichotomized as large changes. Models were adjusted for age, sex, height, heart rate, traditional cardiovascular disease risk factors and baseline kidney measures.

Results: When eGFR was analyzed as a continuous variable, higher baseline CFPWV and CPP, but not AI, were significantly associated with a larger annual decline in eGFR in models adjusted for age, sex, height, heart rate and baseline eGFR, but not after additional adjustment for the mean arterial pressure. When eGFR was analyzed as a categorical variable, higher CFPWV was significantly associated with a decrease in eGFR of ≥3 mL/min/1.73 m 2 /year [odds ratio (OR) 1.53, 95% confidence interval (CI) 1.11-2.13] and higher AI was associated with 30% eGFR decline during follow-up (OR 1.44 and 95% CI 1.03-2.00) in fully adjusted models. None of the tonometry measures was associated with change in UACR.

Conclusions: Abnormalities in vascular health may play a role in large declines in eGFR beyond the traditional cardiovascular disease risks in this older Icelandic cohort.

Keywords: albuminuria; aortic stiffness; chronic kidney disease; estimated glomerular filtration; older people.

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Figures

FIGURE 1
FIGURE 1
Association of baseline arterial tonometry measures and the annual change of eGFR and UACR. OLS, ordinary least squares.
FIGURE 2
FIGURE 2
Analysis of MAP as a mediator of the association between (A) CFPWV and change in eGFR and (B) CPP and change in eGFR. OLS, ordinary least squares. Units of eGFR are ml/min/1.73 m2
See this image and copyright information in PMC

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