Aortic Pulse Pressure Is Associated With Carotid IMT in Chronic Kidney Disease: Report From Chronic Renal Insufficiency Cohort

BACKGROUND: Patients with chronic kidney disease (CKD) have a disproportionate risk of cardiovascular disease. This study was designed to assess the association between two noninvasive measures of cardiovascular risk, pulse wave analysis (PWA), and carotid intima-media thickness (IMT), in a cohort of CKD patients enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study. METHODS: Three hundred and sixty-seven subjects with CKD enrolled in the CRIC study at the University of Pennsylvania site (mean age 59. 9 years, blood pressure 129/74 mm Hg, estimated glomerular filtration rate 48 ml/min/1. 73 m2, IMT 0. 8 mm) had both carotid IMT and PWA measurements. Carotid ultrasound was also used to determine the presence of plaque. PWA was used to determine augmentation index (AI), amplification ratio (AMPR), aortic pulse pressure (CPP), and central aortic systolic pressure (CSP). RESULTS: IMT was significantly associated with all PWA-derived measures. However, on multivariable linear regression analysis, only AMPR (regression coefficient -0. 072, P = 0. 006), CPP (regression coefficient 0. 0025, P < 0. 001), and CSP (regression coefficient 0. 0017, P < 0. 001) remained significantly associated with IMT. The prevalence of carotid plaque in the cohort was 59%. Of the PWA-derived measures, only CPP was significantly associated with the presence of carotid plaque (P < 0. 001). CONCLUSIONS: PWA-derived measures are associated with carotid IMT and plaque in the CKD. Of these measures, CPP was most associated with carotid IMT and plaque.