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Abstract: FR-PO1023

Association of Pulse Wave Velocity with Renal Outcomes in Pre-Dialysis CKD: Results from the Korean Cohort Study for Outcomes in Patients with CKD (KNOW-CKD)

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Yi, Yongjin, Seoul National University Bundang Hospital, Seongnam-si, GyeonGgi-Do, Korea (the Republic of)
  • Kim, Kipyo, Seoul National University Bundang Hospital, Seongnam-si, GyeonGgi-Do, Korea (the Republic of)
  • Jeong, Jong Cheol, Seoul National University Bundang Hospital, Seongnam-si, GyeonGgi-Do, Korea (the Republic of)
  • Kim, Sejoong, Seoul National University Bundang Hospital, Seongnam-si, GyeonGgi-Do, Korea (the Republic of)
  • Chin, Ho Jun, Seoul National University Bundang Hospital, Seongnam-si, GyeonGgi-Do, Korea (the Republic of)
  • Na, Ki Young, Seoul National University Bundang Hospital, Seongnam-si, GyeonGgi-Do, Korea (the Republic of)
  • Chae, Dong-Wan, Seoul National University Bundang Hospital, Seongnam-si, GyeonGgi-Do, Korea (the Republic of)
Background

Vascular stiffness, a common complication of CKD, would inhibit the capacity of arteries to dampen systolic blood pressure, which would lead to increased barotrauma to glomerular capillary. Therefore, we assessed the effect of brachial-ankle pulse wave velocity (baPWV) on renal outcomes in pre-dialysis CKD.

Methods

KNOW-CKD is a currently on-going prospective cohort study of CKD in Korea in which nine major tertiary hospitals are participating (NCT01630486). A total of 1,903 subjects who performed baPWV test and have ankle-brachial index>0.9 was selected. Mean value of right and left baPWV (mbaPWV) was used for analysis. Renal event (RE) was defined by the doubling of serum creatinine or 50% decrease in CKD-EPI eGFR from the baseline values, or the initiation of renal replacement treatment. The subjects were grouped according to quartile value of mbaPWV. The values of mbaPWV in each quartile group were Q1: 857.5–1,292.5 cm/sec, Q2: 1,293.0–1,458.5 cm/sec, Q3: 1,459.0-1,701.5 cm/sec, Q4: 1,702.3-4,632.5 cm/sec respectively.

Results

Of 1,903 subjects, a total of 507 subjects (26.6%) developed RE during the mean follow up period of 3.6 years. Cox regression analysis adjusted by sex, age, CKD-EPI eGFR, urine albumin creatinine ratio (UACR), medical history of diabetes, hypertension, coronary diseases, hypercholesterolemia, smoking and alcohol revealed that each unit increase of ln (mbaPWV) was associated with 91.7% increase in risk for RE (HR=1.92 95% CI ; 1.11-3.32, p=0.021). Time dependent Cox regression adjusted by the same variables revealed that RE increased along with mbaPWV quartile groups (Q1: reference, Q2: HR=2.13 ; 95% CI 1.07-4.23; p=0.032, Q3: HR=2.37; 95% CI 1.12-4.56; p=0.011, Q4: HR=3.43; 95% CI 1.77-6.65; p=0.000, respectively). While unfavorable effect of mbaPWV on RE was consistent in subject with UACR≤ 300 mg/g, this effect disappeared in subject with UACR> 300 mg/g. Unfavorable effect of mbaPWV on RE was more prominent in subjects with CKD-EPI eGFR≥ 45 ml/min/1.73m2 than those with CKD-EPI eGFR< 45 ml/min/1.73m2.

Conclusion

Vascular stiffness was associated the unfavorable renal outcomes in pre-dialysis CKD, particularly in non-proteinuric and early stage CKD.