Brachial-Ankle Pulse Wave Velocity is Associated with Kidney Function Decline in Adults Undergoing Cardiovascular Disease Screening

Background: CKD affects 35 million adults in the US and is associated with high morbidity and mortality. We investigated whether brachial-ankle pulse wave velocity (baPWV), a non-invasive measure of arterial stiffness, was associated with kidney function decline in adults undergoing cardiovascular disease (CVD) screening. Methods: In 1,862 patients referred for an exercise ECG test between 2007-2009, baPWV was measured using an Omron Colin oscillometric device. Creatinine-based GFR was estimated (eGFR Cr ) for participants with available baseline and follow-up creatinine values using the CKD-EPI formula. We performed multivariable linear regression analyses to assess whether baseline baPWV was associated with annualized change in eGFR Cr (∆ eGFR Cr ), after adjustment for age, sex, body mass index (BMI), baseline eGFR Cr , and traditional CVD risk factors, including mean arterial pressure (MAP), diabetes and hypertension diagnoses, nephroprotective medication use, smoking status, and total cholesterol. To determine risk of developing CKD and CKD-free survival time by arterial stiffness subgroups, we performed covariable-adjusted Cox proportional hazards modeling and a Kaplan-Meier survival analysis, respectively. Results: After exclusion of participants with missing covariable data and adjustment for covariables, one standard deviation increase in baPWV was associated with a 0.18 mL/min/1.73 m 2 BSA greater yearly decrease in eGFR Cr ( P =0.023) over a median follow-up time of 13.2 years. Participants with higher baseline baPWV had increased risk of CKD (HR (95% CI), P -value; elevated baPWV: 2.4 (1.1, 5.4), P =0.037; borderline-elevated baPWV: 1.8 (1.1, 3.1), P =0.028) and had a shorter CKD-free survival time (median CKD-free survival time (years); normal baPWV: 16.2; borderline-elevated baPWV: 16.0; elevated baPWV: 15.6 ( P <0.001)). Conclusions: Elevated baPWV, a noninvasive measure of arterial stiffness that can be obtained in the office setting, was associated with decline in kidney function, risk of CKD development, and CKD-free survival in individuals undergoing CVD screening.