Seiji Itano1, Yuichiro Yano2, Hajime Nagasu1, Hirofumi Tomiyama3, Hiroshi Kanegae4, Hirofumi Makino5, Yukihito Higashi6,7, Yusuke Kobayashi8,9, Yuji Sogawa1, Minoru Satoh1, Kenji Suzuki10, Raymond R Townsend11, Matthew Budoff12, George Bakris13, Naoki Kashihara1. 1. Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Okayama, Japan. 2. Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA. 3. Department of Cardiology and Division of Preemptive Medicine for Vascular Damage, Tokyo Medical University, Tokyo, Japan. 4. Genki Plaza Medical Center for Health Care, Tokyo, Japan. 5. Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University, Okayama, Japan. 6. Division of Regeneration and Medicine, Hiroshima University Hospital, Hiroshima, Japan. 7. Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan. 8. Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University Hospital, Yokohama, Japan. 9. Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan. 10. Japan Health Promotion Foundation, Tokyo, Japan. 11. Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 12. Department of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA. 13. American Heart Association Comprehensive Hypertension Center, Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, The University of Chicago Medicine, Chicago, Illinois, USA.
Abstract
BACKGROUND: Our aims were to assess whether arterial stiffness is associated with a higher risk for kidney dysfunction among persons without chronic kidney disease (CKD). METHODS: We analyzed data from the national health checkup system in Japan; for our analyses, we selected records of individuals who completed assessments of cardio-ankle vascular index (CAVI) and kidney function from 2005 to 2016. We excluded participants who had CKD at baseline, defined as the presence of proteinuria or estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2. We compared 2 groups of CAVI measurements-the highest quartile (≧8.1) and the combined lower 3 quartiles (<8.1). We used Cox proportional hazards models to assess associations between these 2 groups and subsequent CKD events, proteinuria, eGFR <60 ml/min/1.73 m2, and rapid eGFR decline (greater than or equal to -3 ml/min/1.73 m2 per year). RESULTS: The mean age of the 24,297 included participants was 46.2 years, and 60% were female. Over a mean follow-up of 3.1 years, 1,435 CKD events occurred. In a multivariable analysis, the hazard ratios with 95% confidence intervals (CIs) for the highest vs. combined lower quartiles of CAVI measurements were 1.3 (1.1, 1.5) for CKD events, 1.3 (0.96, 1.62) for proteinuria, 1.4 (1.1, 1.7) for eGFR <60 ml/min/1.73 m2, and the odds ratio with 95% CI was 1.3 (1.1, 1.4) for rapid eGFR decline. CONCLUSIONS: Persons with CAVI measurements ≧8.1 had a higher risk for CKD events compared with their counterparts with CAVI measurements <8.1. Greater arterial stiffness among adults without CKD may be associated with kidney dysfunction.
BACKGROUND: Our aims were to assess whether arterial stiffness is associated with a higher risk for kidney dysfunction among persons without chronic kidney disease (CKD). METHODS: We analyzed data from the national health checkup system in Japan; for our analyses, we selected records of individuals who completed assessments of cardio-ankle vascular index (CAVI) and kidney function from 2005 to 2016. We excluded participants who had CKD at baseline, defined as the presence of proteinuria or estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2. We compared 2 groups of CAVI measurements-the highest quartile (≧8.1) and the combined lower 3 quartiles (<8.1). We used Cox proportional hazards models to assess associations between these 2 groups and subsequent CKD events, proteinuria, eGFR <60 ml/min/1.73 m2, and rapid eGFR decline (greater than or equal to -3 ml/min/1.73 m2 per year). RESULTS: The mean age of the 24,297 included participants was 46.2 years, and 60% were female. Over a mean follow-up of 3.1 years, 1,435 CKD events occurred. In a multivariable analysis, the hazard ratios with 95% confidence intervals (CIs) for the highest vs. combined lower quartiles of CAVI measurements were 1.3 (1.1, 1.5) for CKD events, 1.3 (0.96, 1.62) for proteinuria, 1.4 (1.1, 1.7) for eGFR <60 ml/min/1.73 m2, and the odds ratio with 95% CI was 1.3 (1.1, 1.4) for rapid eGFR decline. CONCLUSIONS:Persons with CAVI measurements ≧8.1 had a higher risk for CKD events compared with their counterparts with CAVI measurements <8.1. Greater arterial stiffness among adults without CKD may be associated with kidney dysfunction.