The Association Between Aortic Pulse Wave Velocity and Chronic Kidney Disease

We read with interest the article entitled “Progression of Aortic Pulse Wave Velocity in Patients With Chronic Kidney Disease” by Tholen and colleagues1 in a recent issue of The Journal of Clinical Hypertension. They evaluated the natural progression of arterial stiffness (AS) in patients with chronic kidney disease (CKD). Age, systolic blood pressure (BP), and diabetes were associated with accelerated progression. Interestingly, loss of renal function had no significant impact. We have some comments about this study. The acute effects of hemodialysis on arterial stiffness parameters are still debatable.2, 3 Therefore, we wonder about the number of patients receiving hemodialysis in the present study. Indeed, in hemodialyzed patients, arterial stiffness is associated with calcification and progressed with the progression of atherosclerosis.4 Although it has not been replicated, several studies have shown an association between AS and renal function in patients with CKD.5 In the study population, baseline aortic pulse wave velocity (PWV) levels are significantly different in the three groups. Also, this study includes patients at very high risk with a small cohort and results cannot be extrapolated to other clinical situations. β-Blockers can limit the destiffening of the arterial wall or increase its stiffness.6 Tholen and associates1 did not give any information about drug usage other than statins and renin-angiotensin-aldosterone-system blockers. Aortic systolic BP increases with age and after 50 years of age, PWV increases and leads to augmentation of central systolic BP.7 Also, it can be influenced by diurnal variability in BP.8 Should it be expected to draw such a conclusion from only two measurements (baseline and after 12 months) as the authors suggested? Finally, long-term arterial remodeling, which may need several months to develop, contributes to the normalization of AS beyond BP-lowering.9 Therefore, we question the statement that highlights 1 year as a short time interval in the discussion section. None.