DOI: 10.3724/SP.J.1263.2012.03051

Journal of Geriatric Cardiology 2012/9:2 PP.158-165

Association of glomerular filtration rate with arterial stiffness in Chinese women with normal to mildly impaired renal function

Both decreased glomerular filtration rate (GFR) and arterial stiffness were considered as risk factors for atherosclerosis. Previous studies have suggested the association between central arterial stiffness and the degree of GFR loss. Whether decreased GFR contributes to peripheral artery stiffness remains controversial. Moreover, data analyzed from a cohort of Chinese women are rare. Our aim was to explore the relationship between GFR and regional arterial stiffness in Chinese women. Methods In this cross-sectional study, we randomly recruited 1131 adult women residents with GFR ≥ 60 mL/min per 1.73 m2 estimated by the Chinese Modification of Diet in Renal Disease equation from three large communities. Central and peripheral arterial stiffness were estimated simultaneously by measuring carotid-femoral pulse wave velocity (PWVcf) and carotid-radial PWV (PWVcr) using a validated automatic device. Augmentation Index at heart rate 75 beats/minutes (AIx-75) was measured by pulse wave analysis as a composite parameter reflecting both large and distal arterial properties. Results The mean estimated GFR (eGFR) of the study group was 100.05 ± 23.26 mL/minute per 1.73 m2. Subjects were grouped by tertiles of eGFR level. PWVcf and AIx-75 increased ongoing from the top to the bottom eGFR tertile, while the values of PWVcr were comparable. Both univariate Pearson correlations and multiple stepwise regression analyses showed that eGFR significantly correlated to PWVcf, but not to PWVcr and AIx-75. Conclusions In Chinese women with normal to mildly impaired renal function, decreased eGFR affected carotid-to-femoral rather than carotid-to-radial stiffening. This provides rational to conduct future prospective studies to investigate predictors of atherosclerosis in this population.

Key words:Arterial stiffness,Augmentation index,Pulse wave velocity,Glomerular filtration rate,Chinese women

ReleaseDate:2014-07-21 16:18:39

1 Wenger NK. Coronary heart disease: the female heart is vulnerable. Prog Cardiovasc Dis 2003; 46: 199-229.

2 Gu D, Gupta A, Muntner P, et al. Prevalence of cardiovascular disease risk factor clustering among the adult population of China: results from the International Collaborative Study of Cardiovascular Disease in Asia (Inter Asia). Circulation 2005; 112: 658-665.

3 Mosca L, Linfante AH, Benjamin EJ, et al. National study of physician awareness and adherence to cardiovascular disease prevention guidelines. Circulation 2005; 111: 499-510.

4 Yusuf S, Reddy S, Ounpuu S, et al. Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation 2001; 104: 2746-2753.

5 Sarnak MJ, Levey AS, Schoolwerth AC, et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation 2003; 108: 2154-2169.

6 Henry RM, Kostense PJ, Bos G, et al. Mild renal insufficiency is associated with increased cardiovascular mortality: The Hoorn Study. Kidney Int 2002; 62: 1402-1407.

7 Mann JF, Gerstein HC, Pogue J, et al. Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril: the HOPE randomized trial. Ann Intern Med 2001; 134: 629-636.

8 Pannier B, Guerin AP, Marchais SJ, et al. Stiffness of capacitive and conduit arteries: prognostic significance for end-stage renal disease patients. Hypertension 2005; 45: 592-596.

9 Sutton-Tyrrell K, Najjar SS, Boudreau RM, et al. Elevated aortic pulse wave velocity, a marker of arterial stiffness, predicts cardiovascular events in well-functioning older adults. Circulation 2005; 111: 3384-3390.

10 Schillaci G, Pirro M, Mannarino MR, et al. Relation between renal function within the normal range and central and peripheral arterial stiffness in hypertension. Hypertension 2006; 48: 616-621.

11 Laurent S, Boutouyrie P. Arterial stiffness: a new surrogate end point for cardiovascular disease? J Nephrol 2007; 20 Suppl 12: S45-S50.

12 London GM, Blacher J, Pannier B, et al. Arterial wave reflections and survival in end-stage renal failure. Hypertension 2001; 38: 434-438.

13 Ohya Y, Iseki K, Iseki C, et al. Increased pulse wave velocity is associated with low creatinine clearance and proteinuria in a screened cohort. Am J Kidney Dis 2006; 47: 790-797.

14 Ma YC, Zuo L, Chen JH, et al. Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease. J Am Soc Nephrol 2006; 17: 2937-2944.

15 Asmar R, Benetos A, Topouchian J, et al. Assessment of arterial distensibility by automatic pulse wave velocity measurement. Validation and clinical application studies. Hypertension 1995; 26: 485-490.

16 Kawamoto R, Kohara K, Tabara Y, et al. An association between decreased estimated glomerular filtration rate and arterial stiffness. Intern Med 2008; 47: 593-598.

17 Yoshida M, Tomiyama H, Yamada J, et al. Relationships among renal function loss within the normal to mildly impaired range, arterial stiffness, inflammation, and oxidative stress. Clin J Am Soc Nephrol 2007; 2: 1118-1124.

18 Mitchell GF, Parise H, Benjamin EJ, et al. Changes in arterial stiffness and wave reflection with advancing age in healthy men and women: the Framingham Heart Study. Hypertension 2004; 43: 1239-1245.

19 Kimoto E, Shoji T, Shinohara K, et al. Preferential stiffening of central over peripheral arteries in type 2 diabetes. Diabetes 2003; 52: 448-452.

20 Laurent S, Boutouyrie P. Recent advances in arterial stiffness and wave reflection in human hypertension. Hypertension 2007; 49: 1202-1206.

21 Harrison MR, Clifton GD, Berk MR, et al. Effect of blood pressure and afterload on Doppler echocardiographic measurements of left ventricular systolic function in normal subjects. Am J Cardiol 1989; 64: 905-908.

22 Tomiyama H, Arai T, Koji Y, et al. The age-related increase in arterial stiffness is augmented in phases according to the severity of hypertension. Hypertens Res 2004; 27: 465-470.

23 Stehouwer CD, Henry RM, Ferreira I. Arterial stiffness in diabetes and the metabolic syndrome: a pathway to cardiovascular disease. Diabetologia 2008; 51: 527-539.

24 Yasmin, Brown MJ. Similarities and differences between augmentation index and pulse wave velocity in the assessment of arterial stiffness. QJM 1999; 92: 595-600.

25 Wimmer NJ, Townsend RR, Joffe MM, et al. Correlation between pulse wave velocity and other measures of arterial stiffness in chronic kidney disease. Clin Nephrol 2007; 68: 133-143.

26 Woodman RJ, Kingwell BA, Beilin LJ, et al. Assessment of central and peripheral arterial stiffness: studies indicating the need to use a combination of techniques. Am J Hypertens 2005; 18: 249-260.

27 Obara S, Hayashi S, Hazama A, et al. Correlation between augmentation index and pulse wave velocity in rabbits. J Hypertens 2009; 27: 332-340.

28 Dubey RK, Jackson EK, Rupprecht HD, et al. Factors controlling growth and matrix production in vascular smooth muscle and glomerular mesangial cells. Curr Opin Nephrol Hypertens 1997; 6: 88-105.

29 Safar ME, London GM, Plante GE. Arterial stiffness and kidney function. Hypertension 2004; 43: 163-168.

30 Chang C, Chow SN, Hu Y. Age of menopause of Chinese women in Taiwan. Int J Gynaecol Obstet 1995; 49: 191-192.

31 Rexrode KM, Manson JE, Lee IM, et al. Sex hormone levels and risk of cardiovascular events in postmenopausal women. Circulation 2003; 108: 1688-1693.

32 Patrianakos AP, Parthenakis FI, Karakitsos D, et al. Relation of proximal aorta stiffness to left ventricular diastolic function in patients with end-stage renal disease. J Am Soc Echocardiogr 2007; 20: 314-323.