An augmentation index above the median was strongly associated with progression to end-stage renal disease in patients with advanced CKD (HR 17.5; 95% CI 4.43-68.9; p<0.0001).
Cohort (n=35)
Do markers of arterial stiffness predict progression to end-stage renal disease in patients with CKD stages 4 and 5?
Markers of arterial stiffness, including pulse wave velocity and augmentation index, are independent risk factors for progression to end-stage renal disease in patients with advanced chronic kidney disease.
Hazard Ratio: 17.5 (95% CI 4.43–68.9)
p-value: p=<0.0001
BACKGROUND: Factors associated with chronic kidney disease (CKD) contribute to an increased risk of cardiovascular disease and death. The impact of vascular disease on CKD progression is, however, less well studied. METHODS: We examined the effect of markers of vascular disease on the risk of progression to end-stage renal disease (ESRD) in 35 patients with CKD stages 4-5. Superficial femoral artery calcification was assessed by CT scan. Augmentation index (AI) and pulse wave velocity (PWV) were measured by applanation tonometry. RESULTS: After 12.4 (5.5-28.4) months, 22/35 patients (63%) had commenced dialysis. Cox regression analysis identified baseline estimated glomerular filtration rate (hazard ratio, HR, 0.54; 95% CI 0.41-0.70; p < 0.0001), urinary protein (HR 1.84; 95% CI 1.32-2.58; p = 0.0005), PWV (HR 1.30; 95% CI 1.07-1.60; p = 0.01), AI (HR 1.08; 95% CI 1.04-1.14; p = 0.0001) and pack years of smoking (HR 1.01; 95% CI 1.00-1.03; p = 0.02) as independent risk factors for time to ESRD (-2 log likelihood = 86.7; chi(2) = 30.9; p < 0.0001). Repeat analysis using AI as a categorical variable revealed an HR of 17.5 (95% CI 4.43-68.9; p < 0.0001) for time to ESRD in those with AI above versus below the median. CONCLUSIONS: We have identified two markers of arterial stiffness as independent risk factors for progression to ESRD suggesting that vascular disease may contribute to CKD progression.
Taal et al. (2007) conducted a cohort in Chronic kidney disease stages 4 and 5 (n=35). Augmentation index above the median vs. Augmentation index below the median was evaluated on Time to end-stage renal disease (ESRD) (HR 17.5, 95% CI 4.43-68.9, p=<0.0001). An augmentation index above the median was strongly associated with progression to end-stage renal disease in patients with advanced CKD (HR 17.5; 95% CI 4.43-68.9; p<0.0001).