Prevalence of Arterial Stiffness and Associated Factors in Thai Patients with Chronic Kidney Disease and Kidney Transplant Recipients.

BACKGROUND

Patients with chronic kidney disease (CKD), end-stage renal disease (ESRD) with dialysis, and kidney transplant (KT) recipients are associated with increased cardiovascular (CV) morbidity and mortality. Arterial stiffness is a major nontraditional risk factor of CV disease, and increased aortic pulse wave velocity (PWV), the gold standard for arterial stiffness assessment, may predict CV morbidity and mortality in these patients.

OBJECTIVE

The purpose of the present study was to evaluate the prevalence of arterial stiffness in pre-dialysis CKD, ESRD with dialysis patients and KT recipients, and associated factors that exacerbate the condition in order to serve as evidence to search for appropriate therapeutic options.

MATERIAL AND METHOD

This was a cross-sectional study of 169 patients including cases of pre-dialysis CKD stages 3-5, ESRD with hemodialysis (HD), continuous ambulatory peritoneal dialysis (CAPD), kidney transplant (KT) recipients and healthy volunteers. Central blood pressure (BP) and aortic PWV were assessed using the SphygmoCor® CPV Pulse Wave Velocity system (AtCor Medical, Sydney, Australia). Increased arterial stiffness was defined as aortic PWV of ≥12 m/s.

RESULTS

The prevalence rates of arterial stiffness in pre-dialysis CKD, HD, CAPD patients, KT recipients and normal controls were 53.1%, 68.8%, 64.7%, 38.9% and 5.7% respectively, and the mean aortic PWVs were 12.7±2.2, 13.5±2.8, 13.4±2.8, 11.3±1.8 and 9.5±1.7 m/s respectively (p<0.001). The factors associated with arterial stiffness determined by univariate analysis were older age, diabetes, CKD, HD, CAPD, KT recipients, higher brachial and central BP, higher serum phosphate, and calcium-phosphate products. A multivariate model showed that only HD, KT recipients, older age and higher central mean arterial pressure (MAP) were independently associated with increased arterial stiffness, with adjusted odds ratio (95% confidence interval) of 17.71 (2.39-131.04), 9.29 (1.46-59.09), 1.09 (1.05-1.14), and 1.11 (1.06-1.16) respectively.

CONCLUSION

Arterial stiffness was markedly raised in all groups of CKD patients with an overall prevalence of 56%. The highest prevalence of arterial stiffness was found in ESRD patients treated with HD and CAPD. It was shown that the associated factors that independently increased arterial stiffness were HD patients, KT recipients, older age and higher central MAP.