Nagarajarao Harsha S, Musani Solomon K, Cobb Keith E, Pollard James D, Cooper Leroy L, Anugu Anshul, Yano Yuichiro, Moore Josiah A, Tsao Connie W, Dreisbach Albert W, Benjamin Emelia J, Hamburg Naomi M, Vasan Ramachandran S, Mitchell Gary F, Fox Ervin R
Department of Medicine, Texas Tech University of Health Sciences, El Paso, TX.
Department of Medicine, University of Mississippi Medical Center, Jackson, MS.
Kidney Med. 2021 Jul 14;3(5):702-711.e1. doi: 10.1016/j.xkme.2021.03.018. eCollection 2021 Sep-Oct.
RATIONALE & OBJECTIVE: The relation of vascular stiffness, endothelial function, and kidney function is incompletely elucidated in African Americans. Our hypothesis was that increased vascular stiffness and endothelial dysfunction are associated with low estimated glomerular filtration rate (eGFR) and albuminuria in African Americans.
Cross-sectional cohort analysis of data from the Jackson Heart Study.
SETTINGS & PATIENTS: 2,244 Jackson Heart Study participants (2012-2017 after Exam 3) who had undergone noninvasive hemodynamic assessment using arterial tonometry.
Baseline carotid-femoral pulse wave velocity, pulsatile hemodynamics forward wave amplitude, and hyperemic brachial artery flow were measured. Reduced eGFR was defined as eGFR between 15 and 60 mL/min/1.73 m.
Prevalent albuminuria, urinary albumin-creatinine ratio.
2-sample test for continuous variables and χ test for categorical variables in addition to logistic and linear regression models to assess the risk for chronic kidney disease with each proposed hemodynamic variable.
Among 2,244 participants, mean age was 66 ± 11 years and 64% were women. Reduced eGFR was present in 233 (10.4%), and elevated urinary albumin-creatinine ratio, in 232 (10.4%). In multivariable-adjusted analyses, higher carotid-femoral pulse wave velocity was associated with the presence of reduced eGFR (OR, 1.37 [95% CI, 1.08-1.75] per SD; = 0.01) and with prevalent albuminuria (OR, 1.66 [95% CI, 1.32-2.11]; < 0.001). Higher forward wave amplitude was significantly associated with prevalent albuminuria (OR, 1.37 [95% CI, 1.14-1.65]; = 0.001).
Cross-sectional analyses cannot inform causality.
Higher arterial stiffness and pulsatility are associated with higher odds of reduced eGFR in African Americans. Future studies should focus on whether improving arterial stiffness contributes to kidney protection in African Americans.
非裔美国人血管僵硬度、内皮功能与肾功能之间的关系尚未完全阐明。我们的假设是，非裔美国人血管僵硬度增加和内皮功能障碍与估计肾小球滤过率（eGFR）降低及蛋白尿有关。
对杰克逊心脏研究数据进行横断面队列分析。
2244名杰克逊心脏研究参与者（在第3次检查后的2012 - 2017年），他们接受了使用动脉张力测量法进行的无创血流动力学评估。
测量基线颈股脉搏波速度、搏动血流动力学前向波振幅和充血肱动脉血流。eGFR降低定义为eGFR在15至60 mL/min/1.73 m²之间。
蛋白尿患病率、尿白蛋白肌酐比值。
除了使用逻辑回归和线性回归模型评估每个提出的血流动力学变量与慢性肾病风险的关系外，还对连续变量进行双样本t检验，对分类变量进行χ²检验。
在2244名参与者中，平均年龄为66±11岁，64%为女性。233人（10.4%）存在eGFR降低，232人（10.4%）尿白蛋白肌酐比值升高。在多变量调整分析中，较高的颈股脉搏波速度与eGFR降低的存在相关（每标准差的比值比[OR]为1.37[95%置信区间，1.08 - 1.75]；P = 0.01），也与蛋白尿患病率相关（OR为1.66[95%置信区间，1.32 - 2.11]；P < 0.001）。较高的前向波振幅与蛋白尿患病率显著相关（OR为1.37[95%置信区间，1.14 - 1.65]；P = 0.001）。
横断面分析无法说明因果关系。
非裔美国人中较高的动脉僵硬度和搏动性与eGFR降低的较高几率相关。未来的研究应关注改善动脉僵硬度是否有助于非裔美国人的肾脏保护。
