Central blood pressures in early chronic kidney disease: an analysis of CARTaGENE

Background: Vascular stiffness and advanced chronic kidney disease (CKD) are strong determinants of higher central blood pressure (BP) and are associated with high cardiovascular morbidity and mortality. Whether mild-to-moderate CKD is associated with higher central BP independently of other comorbid conditions remains uncertain. Methods: We evaluated the central hemodynamic profile [central systolic BP, central pulse pressure (PP), augmentation index, PP amplification, augmented pressure] of Stage 3 CKD patients and compared it with participants with estimated glomerular filtration rate (eGFR) > 60 mL/min/1.73 m(2) in the CARTaGENE populational cohort through propensity score matching and multivariate regression analyses. Results: Of the 20 004 participants, 13 114 had valid pulse wave analysis and eGFRs > 30 mL/min/1.73 m(2), of which 515 had Stage 3 CKD. These 515 patients had significantly higher peripheral systolic BP (127 +/- 16 versus 125 +/- 15 mmHg, P = 0.01) and central PP (43.0 +/- 11.4 versus 39.7 +/- 10.0 mmHg, P < 0.001) than the control group (eGFR > 60 mL/min/1.73 m(2)). Propensity score matching allowed the creation of 500 pairs with similar clinical characteristics. In this matched cohort, central BPs were similar in Stage 3 CKD patients compared with controls (central PP 42.9 +/- 11.3 versus 43.7 +/- 11.3 mmHg, P = 0.3). Multivariate analysis using data from all patients also found that the higher central hemodynamic readings found in Stage 3 CKD patients disappeared after adjusting for comorbid conditions. In a subset of 609 participants in whom albuminuria levels were measured, urine albumin excretion was not independently associated with higher central hemodynamic indices. Conclusion: In this large cohort from the general population, early CKD and albuminuria was not independently associated with detrimental central hemodynamic parameters.