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• W2808142417 abstract "After more than a decade of studying arterial stiffness in a nondialysis cohort of patients with CKD, several take home points are evident, as listed in Box 1. An emerging finding in both the CRIC Study and other recent meta-analyses18Vlachopoulos C. Aznaouridis K. Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis.J Am Coll Cardiol. 2010; 55: 1318-1327Crossref PubMed Scopus (2892) Google Scholar, 19Ben-Shlomo Y. Spears M. Boustred C. et al.Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects.J Am Coll Cardiol. 2014; 63: 636-646Crossref PubMed Scopus (1145) Google Scholar is that arterial stiffness measurements add predictive value to the office or clinic BP. Treatment of hypertension does not necessarily improve arterial stiffness. The vast majority of CRIC participants are using antihypertensive medications and with reasonably good BP control,48Muntner P. Anderson A. Charleston J. et al.Hypertension awareness, treatment, and control in adults with chronic kidney disease: results from the Chronic Renal Insufficiency Cohort (CRIC) Study.Am J Kidney Dis. 2009; 55: 441-451Abstract Full Text Full Text PDF PubMed Scopus (259) Google Scholar, 49Lash J.P. Go A.S. Appel L.J. et al.Chronic Renal Insufficiency Cohort (CRIC) Study: baseline characteristics and associations with kidney function.Clin J Am Soc Nephrol. 2009; 4: 1302-1311Crossref PubMed Scopus (420) Google Scholar yet the spectrum of arterial stiffness shows that about one-third of our cohort have PWV ≥ 10 m/s, which is internationally considered to be the top limit of normal.50Van Bortel L.M. Laurent S. Boutouyrie P. et al.Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity.J Hypertens. 2012; 30: 445-448Crossref PubMed Scopus (1251) Google Scholar As shown in Figure 4, from an early analysis of CRIC data, the relationship of systolic BP at the time of CRIC enrollment was not as reflective of previous CVD as was the first PWV measurement. The degree of comorbidity in patients with CKD, particular affecting the CV system, argues that there may be room for further improvement in CKD-related outcomes through interventions that destiffen the aorta. Discovering and testing agents that destiffen the aorta is a gap in our current knowledge. An additional gap is in the area of aortic calcium deposition. Calcified aortas are stiffer, but there is little we can do about decalcification and we have no evidence to say that decalcification will be beneficial. One of the most important consequences of CKD and ESRD is the alarming incidence of sudden cardiac death.51Deo R. Lin F. Vittinghoff E. Tseng Z.H. Hulley S.B. Shlipak M.G. Kidney dysfunction and sudden cardiac death among women with coronary heart disease.Hypertension. 2008; 51: 1578-1582Crossref PubMed Scopus (44) Google Scholar, 52Makar M.S. Pun P.H. Sudden cardiac death among hemodialysis patients.Am J Kidney Dis. 2017; 69: 684-695Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar, 53Suzuki T. Agarwal S.K. Deo R. et al.Kidney function and sudden cardiac death in the community: the Atherosclerosis Risk in Communities (ARIC) Study.Am Heart J. 2016; 180: 46-53Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar Although not formally analyzed in the CRIC Study (yet), it may be that arterial stiffness is a predictor of sudden cardiac death, possibly because the long-term consequences of arterial stiffness predispose to left ventricular hypertrophy, jeopardizing the endocardium to arrhythmia because it is vulnerable to the effects of increased afterload,54Kim D. Shim C.Y. Hong G.R. et al.Differences in left ventricular functional adaptation to arterial stiffness and neurohormonal activation in patients with hypertension: a study with two-dimensional layer-specific speckle tracking echocardiography.Clin Hypertens. 2017; 23: 21Crossref PubMed Scopus (19) Google Scholar or because of the effects of arterial stiffness on baroreceptor dysfunction.55Okada Y. Galbreath M.M. Shibata S. et al.Relationship between sympathetic baroreflex sensitivity and arterial stiffness in elderly men and women.Hypertension. 2012; 59: 98-104Crossref PubMed Scopus (125) Google Scholar Future endeavors in the CRIC Study plan to focus more intensely on these aspects of CKD epidemiology. For now, PWV measures are still mainly used in research until clinical recommendations of what to do based on their measurement are formulated.Box 1Take Home Messages Regarding Arterial Stiffness in the CRIC Study✓Arterial stiffness is worse in diabetic compared with nondiabetic patients.32Townsend R.R. Wimmer N.J. Chirinos J.A. et al.Aortic PWV in chronic kidney disease: a CRIC ancillary study.Am J Hypertens. 2010; 23: 282-289Crossref PubMed Scopus (174) Google Scholar✓Arterial stiffness worsens as kidney function declines irrespective of cause of CKD.32Townsend R.R. Wimmer N.J. Chirinos J.A. et al.Aortic PWV in chronic kidney disease: a CRIC ancillary study.Am J Hypertens. 2010; 23: 282-289Crossref PubMed Scopus (174) Google Scholar✓Arterial stiffness is linked to proteinuria in diabetic patients with CKD.35Weir M.R. Townsend R.R. Fink J.C. et al.Hemodynamic correlates of proteinuria in chronic kidney disease.Clin J Am Soc Nephrol. 2011; 6: 2403-2410Crossref PubMed Scopus (33) Google Scholar✓Arterial stiffness is associated with higher central pulse pressures in CKD.34Townsend R.R. Chirinos J.A. Parsa A. et al.Central pulse pressure in chronic kidney disease. A Chronic Renal Insufficiency Cohort ancillary study.Hypertension. 2010; 56: 518-524Crossref PubMed Scopus (34) Google Scholar✓Arterial stiffness is linked to bone & mineral disorders.37Scialla J.J. Leonard M.B. Townsend R.R. et al.Correlates of osteoprotegerin and association with aortic pulse wave velocity in patients with chronic kidney disease.Clin J Am Soc Nephrol. 2011; 6: 2612-2619Crossref PubMed Scopus (44) Google Scholar✓Arterial stiffness predicts death and CKD progression to ESRD.38Townsend R.R. Anderson A.H. Chirinos J.A. et al.Association of pulse wave velocity with chronic kidney disease progression and mortality: findings from the CRIC study.Hypertension. 2018; 71: 1101-1107Crossref PubMed Scopus (66) Google Scholar✓Arterial stiffness predicts new-onset HF in CKD.39Chirinos J.A. Khan A.M. Bansal N. et al.Arterial stiffness, central pressures and incident hospitalized heart failure in the Chronic Renal Insufficiency Cohort (CRIC) Study.Circ Heart Fail. 2014; 7: 709-716Crossref PubMed Scopus (64) Google Scholar✓Arterial stiffness is worse in CKD patients with masked hypertension.42Drawz P.E. Alper A.B. Anderson A.H. et al.Masked hypertension and elevated nighttime blood pressure in CKD: prevalence and association with target organ damage.Clin J Am Soc Nephrol. 2016; 11: 642-652Crossref PubMed Scopus (121) Google ScholarAbbreviations: CKD, chronic kidney disease; CRIC, Chronic Renal Insufficiency Cohort; ESRD, end-stage renal disease; HF, heart failure.Figure 4Percentage of Chronic Renal Insufficiency Cohort (CRIC) Study participants (y-axis) who indicated the presence of any prior cardiovascular disease (CVD; heart failure, heart attack, stroke, peripheral arterial disease) by (left panel) tertiles of pulse wave velocity and (right panel) tertiles of systolic blood pressure in the CRIC Study.View Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
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• W2808142417 date "2019-02-01" @default.
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• W2808142417 title "Arterial Stiffness in CKD: A Review" @default.
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