Associations Between Kidney Disease Measures and Regional Pulse Wave Velocity in a Large Community-Based Cohort: The Atherosclerosis Risk in Communities (ARIC) Study
Associations Between Kidney Disease Measures and Regional Pulse Wave Velocity in a Large Community-Based Cohort: The Atherosclerosis Risk in Communities (ARIC) Study
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DOI：
10.1053/j.ajkd.2018.04.018
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发表时间：
2018-11-01
影响因子：
13.2
通讯作者：
Matsushita, Kunihiro
中科院分区：
文献类型：
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作者：
Kim, Esther D.;Tanaka, Hirofumi;Matsushita, Kunihiro
原理与目的：动脉僵硬度被认为是心肾相互作用的介质。然而，以前的研究报道了慢性肾脏疾病（CKD）和动脉硬化之间的不一致关系，并且通过使用估计的肾小球滤过率（eGFR）或白蛋白-肌酐比率（ACR）以及在有限的节段检查动脉硬化而受到限制。研究设计：横断面。2011年至2013年期间，3，424名66至90岁的社区动脉粥样硬化（ARIC）研究参与者。预测因素：eGFR和ACR。结果：6个节段的脉搏波速度（PWV）：颈动脉-股动脉（cfPWV）、心脏-颈动脉（hcPWV）和心脏-股动脉（hfPWV），反映中心僵硬度;心脏-踝关节（haPWV）和肱-踝关节（baPWV），代表中心和外周僵硬度;以及股-踝关节（faPWV），表示外周僵硬度。多重线性和逻辑回归模型，以量化eGFR和ACR与连续PWV和PWV升高（在最高的四分位数）的关联，分别为：调整年龄，性别和种族后，较高的cfPWV和hfPWV始终与较低的eGFR和较高的ACR。ACR越高，haPWV和baPWV也越高。在调整其他混杂因素后，两种CKD指标与cfPWV升高的独立相关性保持一致（eGFR每降低15 mL/min/1.73 m（2），cfPWV升高的OR为1.09 [95% CI，1.01-1.18]，ACR每升高4倍，OR为1.20 [95% CI，1.07-1.33]）。ACR升高也与hfPWV和haPWV升高相关（hfPWV升高和haPWV升高的每4倍ACR的OR分别为1.25 [95% CI，1.12-1.39]和1.19 [95% CI，1.06-1.33]）。eGFR较低与baPWV和faPWV升高的几率较低相关（eGFR每降低15 mL/min/1.73 m（2）的OR分别为0.92 [95% CI，0.84-0.99]和0.91 [95% CI，0.85-0.99]）。局限性：无法说明CKD指标和动脉僵硬度之间的时间性。较低的eGFR和较高的ACR均与中心动脉僵硬度指标独立相关，ACR的相关性强于eGFR。我们的研究结果表明，中央动脉僵硬度可能是一个重要的病理生理表型的血管疾病的慢性肾脏病。
Rationale & Objective: Arterial stiffness is suggested as a mediator of cardiorenal interaction. However, previous studies reported inconsistent associations between chronic kidney disease (CKD) and arterial stiffness and were limited by using either estimated glomerular filtration rate (eGFR) or albumin-creatinine ratio (ACR) and examining arterial stiffness at limited segments.Study Design: Cross-sectional.Setting & Participants: 3,424 Atherosclerosis in Communities (ARIC) Study participants aged 66 to 90 years during 2011 to 2013.Predictors: eGFR and ACR.Outcome: Pulse wave velocity (PWV) at 6 segments: carotid-femoral (cfPWV), heart-carotid (hcPWV), and heart-femoral (hfPWV), reflecting central stiffness; heart-ankle (haPWV) and brachial-ankle (baPWV), representing both central and peripheral stiffness; and femoral-ankle (faPWV), indicating peripheral stiffness.Analytical Approach: Multiple linear and logistic regression models to quantify the associations of eGFR and ACR with continuous PWV and elevated PWV (in the highest quartile), respectively.Results: After adjusting for age, sex, and race, higher cfPWV and hfPWV were consistently associated with lower eGFR and higher ACR. Higher haPWV and baPWV were also observed with higher ACR. The independent association of both CKD measures with elevated cfPWV remained consistent after adjusting for additional confounders (ORs of elevated cfPWV were 1.09 [95% CI, 1.01-1.18] per 15-mL/min/1.73 m(2) lower eGFR and 1.20 [95% CI, 1.07-1.33] per 4-fold higher ACR). Higher ACR was also associated with elevated hfPWV and haPWV (ORs per 4-fold higher ACR were 1.25 [95% CI, 1.12-1.39] for elevated hfPWV and 1.19 [95% CI, 1.06-1.33] for elevated haPWV). Lower eGFR was associated with lower odds of elevated baPWV and faPWV (ORs per 15-mL/min/1.73 m(2) lower eGFR were 0.92 [95% CI, 0.84-0.99] and 0.91 [95% CI, 0.85-0.99], respectively).Limitation: Unable to address temporality between CKD measures and arterial stiffness.Conclusions: Both lower eGFR and higher ACR are independently associated with measures of central arterial stiffness, with stronger associations for ACR over eGFR. Our findings suggest that central arterial stiffness may be an important pathophysiologic phenotype of vascular disease in CKD.