Determinants of change in arterial stiffness over 5 years in early chronic kidney disease

BackgroundArterial stiffness is an established and potentially modifiable risk factor for cardiovascular disease, associated with chronic kidney disease. There have been few studies to evaluate progression of arterial stiffness over time or factors that contribute to this, particularly in early chronic kidney disease. We therefore investigated arterial stiffness over 5 years in an elderly population with chronic kidney disease stage 3, cared for in primary care.Methods1741 persons with estimated GFR 30-59mL/min/1.73m2 underwent detailed clinical and biochemical assessment at baseline, year 1 and 5. Carotid to femoral pulse wave velocity (PWV) was measured to assess arterial stiffness using a Vicorder™ device.Results970 participants had PWV assessments at baseline and 5 years. PWV increased significantly by a mean of 1.1 m/s (from 9.7±1.9 to 10.8±2.1m/s). Multivariable linear regression analysis identified the following independent determinants of ΔPWV at year 5: baseline age, diabetes status, baseline systolic and diastolic blood pressure (BP), baseline PWV, ΔPWV at one year, Δ systolic BP over 5 years and Δ serum bicarbonate over 5 years (R2=0.38 for equation).ConclusionsWe observed a clinically significant increase in PWV over 5 years in a cohort with early chronic kidney disease despite reasonably well controlled hypertension. Measures of blood pressure were identified as the most important modifiable determinant of change in PWV suggesting that interventions to prevent arterial disease should focus on improved control of blood pressure, particularly in those who evidence an early increase in PWV. These hypotheses should now be tested in prospective trials