Abstract: TH-PO449

Determinants of Change in Arterial Stiffness over 5 Years in Early CKD

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

  • Mcintyre, Natasha Juliette, The University of Nottingham, Derby, United Kingdom
  • Shardlow, Adam, The University of Nottingham, Derby, United Kingdom
  • Fluck, Richard J., The Royal Derby Hospital, Derby, United Kingdom
  • McIntyre, Christopher W., Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
  • Taal, Maarten W., The University of Nottingham, Derby, United Kingdom
Background

Arterial stiffness (AS) is an established risk factor for cardiovascular disease (CVD) associated with CKD but there have been few studies to evaluate progression of AS over time or factors that contribute to this, particularly in early CKD, where most care is carried out in a primary care based setting. We therefore investigated AS in an elderly population with CKD stage 3 over 5 years.

Methods

1741 persons with estimated GFR 59-30mL/min/1.73m2 were recruited into the Renal Risk in Derby (RRID) study from Primary Care practices. Clinical assessments were completed at baseline, year 1 and 5. Carotid to femoral pulse wave velocity (PWV) was measured as a marker of AS, using a Vicorder™ device (Skidmore Medical Ltd, Bristol, UK). 978 participants had PWV assessments at baseline and 5 years and are included in this analysis.

Results

Changes in important variables over time are shown in the table. In our population, PWV increased significantly by 1.1m/sec over 5 years.Univariate analysis revealed significant correlations between ΔPWV at year 5 and previously identified risk factors for CVD. Multivariable linear regression analysis identified independent determinants of ΔPWV (R2=0.37 for equation). These were Baseline Age (β=0.152, p<0.0001); Diabetes Mellitus (β=0.075, p=0.004); Baseline Systolic BP (β=0.112, p<0.0001); Baseline PWV (β= -0.342, p<0.0001); ΔPWV at year 1 (β=0.318, p<0.0001); ΔSerum Protein at year 5 (β=0.059, p=0.027); ΔSystolic BP at 5 years (β=0.214, p<0.0001).

Conclusion

We observed a clinically significant increase in PWV over 5 years in a primary care based cohort of elderly persons with early CKD. Systolic BP was identified as the most important modifiable determinant of change in PWV suggesting that interventions to prevent arterial disease should focus on control of blood pressure in this population.

Characteristics at 5 year follow up n=978
 BaselineYear 1Year 5
Age(years)70±971±975±9‡
Gender Male378(39)  
Diabetes Mellitus134(14)  
eGFR EPI(mL/min/1.732)55.7±11.755±12.754.3±15.2‡
Systolic BP(mmHg)133±17130±16139±20‡
Diastolic BP(mmHg)74±1171±1075±11‡
Pulse Wave Velocity(m/sec)9.7±1.99.5±1.810.8±2.1‡
UACR(mg/mmol)0.23(0.0-1.1)0.50(0.2-1.6)0.67(0.0-3.2)

‡P<0.05 versus baseline value