Abstract: TH-PO450

Elevated Pulse Amplification in Advanced Kidney Diseases

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 303 CKD: Epidemiology, Outcomes - Cardiovascular

Author

  • Takenaka, Tsuneo, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan
Background

The progression of chronic kidney disease (CKD) inverts arterial stiffness gradient. However, central haemodynamic pressure profiles in CKD have not been fully examined. A cross-sectional study was performed to assess the relationship between CKD stage and central haemodynamic processes.

Methods

The subjects were 2020 hypertensive patients who had undergone echocardiography and had their serum creatinine levels. Radial tonometry was applied in all patients to measure central blood pressure, and they were classified according to six CKD stages based on their estimated glomerular filtration rate (eGFR).

Results

Central (PP2) and brachial pulse pressure (PP) were elevated at stages 3a and 3b, respectively. Diastolic blood pressure (DBP) at stage 1 was higher than at the other stages. The left ventricular mass index (LVMI) was greater at CKD stages 3b-5 than that at stage 1. Either PP or PP2 is sensitive in detecting the presence of left ventricular hypertrophy (LVH), raising the possiblity that central hemodynamic changes in CKD progression participate in lowering the power of PP2 in predicting LVH in treated hypertensive patients. Age, weight, pulse rate, brachial blood pressures, and antihypertensive medication differed among the six stages. As shown in figure, pulse amplification adjusted with these confounders was the lowest in CKD stages 3a and 3b.

Conclusion

The present observations that LVMI was increased at CKD stages 3b-5 support that cardiovascular risk is higher in CKD stages 3b and later. Our findings indicate that pulse amplification is inverted in CKD stages 4 and 5, and suggest that aortic stiffening inadequately reduces PP in advanced CKD, which accounts for a high prevalence of micro- as well as macrovascular diseases of the brain and kidney.Taken together, these results implicate that CKD3b comes of age as an index for timely cardiovascular screening.

Funding

  • Government Support - Non-U.S.