Aortic pulse wave velocity, central pulse pressure, augmentation index and chronic kidney disease progression in individuals with type 2 diabetes: a 3-year prospective study

被引:12
作者
Liu, Jian-Jun [1 ]
Liu, Sylvia [1 ]
Lee, Janus [1 ]
Gurung, Resham L. [1 ]
Yiamunaa, M. [1 ]
Ang, Keven [1 ]
Shao, Yi Ming [1 ]
Choo, Robin W. M. [2 ]
Tavintharan, Subramaniam [3 ]
Tang, Wern Ee [4 ]
Sum, Chee Fang [3 ]
Lim, Su Chi [3 ,5 ,6 ]
机构
[1] Khoo Teck Puat Hosp, Clin Res Unit, Singapore 768828, Singapore
[2] Geriatr Educ & Res Inst, Singapore 768024, Singapore
[3] Admiralty Med Ctr, Diabet Ctr, Singapore 730676, Singapore
[4] Natl Healthcare Grp Polyclin, Singapore 138543, Singapore
[5] Natl Univ Singapore, Saw Swee Hock Sch Publ Heath, Singapore 117549, Singapore
[6] Khoo Teck Puat Hosp, Diabet Ctr, 90 Yishun Cent, Singapore 768828, Singapore
基金
英国医学研究理事会;
关键词
Arterial stiffness; Pulse wave velocity; Central pulse pressure; Chronic kidney disease; Type; 2; diabetes; EXPERT CONSENSUS DOCUMENT; ARTERIAL STIFFNESS; RENAL-FUNCTION; OLDER-ADULTS; DECLINE; HYPERTENSION; ASSOCIATION; CKD;
D O I
10.1186/s12882-020-02024-z
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
BackgroundPulse wave velocity (PWV), central pulse pressure and augmentation index are arterial stiffness- related hemodynamic parameters but their associations with renal outcome are still controversial. We hereby aim to study, 1) which hemodynamic parameter is independently associated with progressive chronic kidney disease (CKD), 2) the association of 3-year change in PWV with CKD progression and, 3) the additive predictive value of PWV for progressive CKD.MethodsCarotid- femoral PWV, central pulse pressure and augmentation index were measured in 1444 participants with type 2 diabetes at baseline and 3years apart. Progressive CKD was defined as confirmed eGFR decline 40% or greater.ResultsIn the follow-up, 102 participants experienced progressive CKD. All 3 hemodynamic parameters were significantly associated with progressive CKD In univariable analysis. However, only PWV remained statistically significant after adjustment for known clinical risk factors and the other 2 hemodynamic parameters (OR 1.14 [95% CI 1.01-1.29] per m/s increment). One m/s regression (decrement) in PWV in the 3-year follow-up was associated with 26% lower adjusted- risk of progressive CKD (OR 0.74, 95% CI 0.56-0.97). Adding PWV onto traditional risk factor- based model significantly improved classification (net reclassification improvement 0.25, 95% CI 0.05-0.45, P =0.01) and positive prediction rate (24.5 to 32.3%).ConclusionsOf 3 arterial stiffness- related hemodynamic parameters, only PWV is independently associated with progressive CKD. PWV may be a potential intervention target to mitigate risk of CKD progression and also a biomarker to improve risk-stratification of adverse renal outcome in individuals with type 2 diabetes.
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页数:9
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