Beros Angela, Sluyter John, Hughes Alun, Hametner Bernhard, Wassertheurer Siegfried, Scragg Robert
School of Population Health, University of Auckland, Auckland, New Zealand.
Institute of Cardiovascular Sciences, University College London, London, UK.
J Nephrol. 2024 Jun;37(5):1241-1250. doi: 10.1007/s40620-024-01968-x. Epub 2024 May 29.
BACKGROUND/AIMS: Evidence from large population-based cohorts as to the association of arterial stiffness and incident chronic kidney disease (CKD) is mixed. This large population-based study aimed to investigate whether arterial stiffness, assessed oscillometrically, was associated with incident CKD.
The study population comprised 4838 participants from the Vitamin D Assessment (ViDA) Study without known CKD (mean ± SD age = 66 ± 8). Arterial stiffness was assessed from 5 April, 2011 to 6 November, 2012 by way of aortic pulse wave velocity, estimated carotid-femoral pulse wave velocity, and aortic pulse pressure. Incident CKD was determined by linkage to national hospital discharge registers. Cox proportional hazards regression was used to assess the risk of CKD in relation to chosen arterial stiffness measures over the continuum and quartiles of values.
During a mean ± SD follow-up of 10.5 ± 0.4 years, 376 participants developed incident CKD. Following adjustment for potential confounders, aortic pulse wave velocity (hazard ratio (HR) per SD increase 1.69, 95% CI 1.45-1.97), estimated carotid-femoral pulse wave velocity (HR per SD increase 1.84, 95% CI 1.54-2.19), and aortic pulse pressure (HR per SD increase 1.37, 95% CI 1.22-1.53) were associated with the incidence of CKD. The risk of incident CKD was, compared to the first quartile, higher in the fourth quartile of aortic pulse wave velocity (HR 4.72, 95% CI 2.69-8.27; P < 0.001), estimated carotid-femoral pulse wave velocity (HR 4.28, 95% CI 2.45-7.50; P < 0.001) and aortic pulse pressure (HR 2.71, 95% CI 1.88-3.91; P < 0.001).
Arterial stiffness, as measured by aortic pulse wave velocity, estimated carotid-femoral pulse wave velocity, and aortic pulse pressure may be utilised in clinical practice to help identify people at risk of future CKD.
www.anzctr.org.au identifier:ACTRN12611000402943.
背景/目的：来自大型人群队列研究的关于动脉僵硬度与慢性肾脏病（CKD）发病之间关联的证据并不一致。这项大型人群研究旨在调查通过示波法评估的动脉僵硬度是否与CKD发病有关。
研究人群包括4838名来自维生素D评估（ViDA）研究的无CKD病史的参与者（平均年龄±标准差=66±8岁）。在2011年4月5日至2012年11月6日期间，通过主动脉脉搏波速度、估计的颈动脉-股动脉脉搏波速度和主动脉脉压来评估动脉僵硬度。通过与国家医院出院登记系统的关联来确定CKD发病情况。使用Cox比例风险回归来评估在连续值范围和四分位数中选定的动脉僵硬度测量指标与CKD风险之间的关系。
在平均±标准差为10.5±0.4年的随访期间，376名参与者发生了CKD。在对潜在混杂因素进行调整后，主动脉脉搏波速度（每标准差增加的风险比（HR）为1.69，95%置信区间为1.45-1.97）、估计的颈动脉-股动脉脉搏波速度（每标准差增加的HR为1.84，95%置信区间为1.54-2.19）和主动脉脉压（每标准差增加的HR为1.37，95%置信区间为1.22-1.53）与CKD发病率相关。与第一四分位数相比，主动脉脉搏波速度第四四分位数的CKD发病风险更高（HR为4.72，95%置信区间为2.69-8.27；P<0.001），估计的颈动脉-股动脉脉搏波速度第四四分位数的发病风险更高（HR为4.28，95%置信区间为2.45-7.50；P<0.001），主动脉脉压第四四分位数的发病风险更高（HR为2.71，95%置信区间为1.88-3.91；P<0.001）。
通过主动脉脉搏波速度、估计的颈动脉-股动脉脉搏波速度和主动脉脉压测量的动脉僵硬度可在临床实践中用于帮助识别未来有CKD风险的人群。
