Background: Chronic kidney disease (CKD) is characterized by aortic stiffness and increased cardiovascular mortality. In end-stage renal disease, aortic stiffness predicts mortality, whereas this role remains uncertain in mild-to-moderate CKD. We aimed to investigate whether aortic pulse wave velocity (aPWV) predicts mortality and renal disease progression in CKD patients.
Methods: We enrolled 135 CKD patients stages 2–4 [estimated glomerular filtration rate (eGFR): 41.1 (28.5–61.6) ml/min per 1.73 m2] in the study and assessed aPWV. The combined renal end-point was defined as at least 50% decline in renal function and/or start of renal replacement therapy.
Results: During the observational period of 42 (30–50) months six patients were lost of follow-up, 13 patients died and 16 patients reached the combined renal end-point. Stratification according to the mean of aPWV (10 m/s), Kaplan–Meier analysis revealed increased mortality with aPWV ≥10 m/s (log-rank P < 0.05). Stepwise logistic regression analysis confirmed aPWV as an independent predictor for mortality in CKD stage 2–4. The hazard ratio of mortality in the cohort with an aPWV at least 10 m/s was 5.1 (1.1–22.9). By contrast, Kaplan–Meier analysis revealed no effect of aPWV on the combined renal end-point (log-rank P = 0.90).
Discussion: These results provide the first direct evidence that in patients with CKD stage 2–4, increased aortic stiffness determined by aPWV is a strong independent predictor of all-cause mortality.
aDepartment of Nephrology, Klinikum rechts der Isar, Technische Universität München, Germany
bHealth & Environment Department, AIT Austrian Institute of Technology, Vienna, Austria
cNephrological Clinic Weissenburg, Weissenburg, Germany
Correspondence to PD Dr med. Marcus Baumann, PhD, (NL), Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str.22, 81675 München, Germany. Tel: +49 89 4140 6704; fax: +49 89 4140 4878; e-mail: firstname.lastname@example.org
Abbreviations: aPWV, aortic pulse wave velocity; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; RAS, renin–angiotensin system; uPCR, urinary protein–creatinine ratio
Received 22 August, 2013
Revised 12 December, 2013
Accepted 12 December, 2013