Key result
Brachial artery systolic blood pressure and aortic pulse wave velocity are significantly associated with variations in proteinuria in patients with chronic kidney disease, particularly in diabetics.
Why the study?
Are central measures of BP or vascular stiffness associated with increased risk of proteinuria in patients with chronic kidney disease?
Cross-Sectional (n=2,144)
Yes
Are central measures of BP or vascular stiffness associated with increased risk of proteinuria in patients with chronic kidney disease?
Effect estimate: R2 = 0.40
p-value: p=<0.0001
Brachial artery systolic blood pressure and aortic pulse wave velocity (a measure of vascular stiffness) are associated with variations in proteinuria in patients with CKD, with pulse wave velocity providing incremental value in diabetic patients.
May inform risk stratification in diabetic CKD; leaves open whether targeting aortic stiffness slows proteinuria progression.
BACKGROUND AND OBJECTIVES: Brachial artery measures of BP are associated with increasing degrees of proteinuria. Whether central measures of BP or vascular stiffness are associated with increased risk of proteinuria in patients with chronic kidney disease (CKD) is unknown. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Measurements of central and brachial artery BP, and aortic pulse wave velocity (PWV) were performed in a cross-sectional cohort of patients with CKD (n = 2144) from the Chronic Renal Insufficiency Cohort (CRIC) study to determine factors which predict increased risk of proteinuria. Multivariate analysis stratified by diabetes included age, ethnicity, gender, estimated glomerular filtration rate (GFR), waistline, smoking, heart rate, and medications to evaluate the relationship of hemodynamic factors and proteinuria. RESULTS: Brachial artery systolic BP (SBP) was important as an explanatory factor for variations in proteinuria among both diabetics (R(2) = 0.40, P < 0.0001) and non diabetics (R(2) = 0.38, P < 0.001). Measures of peripheral pulse pressure (PP), central SBP, and central pulse pressure added little to the explained variation in proteinuria beyond brachial artery SBP, whereas PWV as a measure of vascular stiffness incrementally accounted for a significant portion of variation in proteinuria beyond that explained by brachial artery SBP in diabetics (R(2) = 0.42, P < 0.001) but not non diabetics. CONCLUSIONS: Brachial artery SBP and PWV are both associated with variations in proteinuria in patients with CKD.
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Townsend et al. (2011) conducted a cross-sectional in Chronic Kidney Disease (n=2,144). Brachial artery systolic blood pressure and aortic pulse wave velocity was evaluated on Log-transformed 24-hour urine protein (R2 = 0.40, p=<0.0001). Brachial artery systolic blood pressure and aortic pulse wave velocity are significantly associated with variations in proteinuria in patients with chronic kidney disease, particularly in diabetics.
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