Central blood pressures in early chronic kidney disease: an analysis of CARTaGENE

Nephrol Dial Transplant. 2017 Jun 1;32(6):976-983. doi: 10.1093/ndt/gfw059.

Abstract

Background: Vascular stiffness and advanced chronic kidney disease (CKD) are strong determinants of higher central blood pressure (BP) and are associated with high cardiovascular morbidity and mortality. Whether mild-to-moderate CKD is associated with higher central BP independently of other comorbid conditions remains uncertain.

Methods: We evaluated the central hemodynamic profile [central systolic BP, central pulse pressure (PP), augmentation index, PP amplification, augmented pressure] of Stage 3 CKD patients and compared it with participants with estimated glomerular filtration rate (eGFR) >60 mL/min/1.73 m 2 in the CARTaGENE populational cohort through propensity score matching and multivariate regression analyses.

Results: Of the 20 004 participants, 13 114 had valid pulse wave analysis and eGFRs >30 mL/min/1.73 m 2 , of which 515 had Stage 3 CKD. These 515 patients had significantly higher peripheral systolic BP (127 ± 16 versus 125 ± 15 mmHg, P = 0.01) and central PP (43.0 ± 11.4 versus 39.7 ± 10.0 mmHg, P <0.001) than the control group (eGFR >60 mL/min/1.73 m 2 ). Propensity score matching allowed the creation of 500 pairs with similar clinical characteristics. In this matched cohort, central BPs were similar in Stage 3 CKD patients compared with controls (central PP 42.9 ± 11.3 versus 43.7 ± 11.3 mmHg, P = 0.3). Multivariate analysis using data from all patients also found that the higher central hemodynamic readings found in Stage 3 CKD patients disappeared after adjusting for comorbid conditions. In a subset of 609 participants in whom albuminuria levels were measured, urine albumin excretion was not independently associated with higher central hemodynamic indices.

Conclusion: In this large cohort from the general population, early CKD and albuminuria was not independently associated with detrimental central hemodynamic parameters.

Keywords: albuminuria; central blood pressure; central pulse pressure; chronic kidney disease; pulse wave analysis.

MeSH terms

  • Adult
  • Aged
  • Albuminuria / complications
  • Albuminuria / epidemiology
  • Albuminuria / physiopathology
  • Arterial Pressure
  • Cross-Sectional Studies
  • Disease Susceptibility
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Hypertension / diagnosis*
  • Hypertension / epidemiology
  • Hypertension / etiology
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Propensity Score
  • Pulse Wave Analysis
  • Renal Insufficiency, Chronic / complications
  • Renal Insufficiency, Chronic / epidemiology
  • Renal Insufficiency, Chronic / physiopathology*