Chronic kidney disease (CKD) is associated with an increased risk of cardiovascular disease, and thus is a major worldwide public health problem. Recently, an estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease equation for Japanese patients was proposed by the Japanese Society of Nephrology. However, the role of eGFR in the assessment of atherosclerosis is not well understood in Japanese patients. We analyzed the relationship between eGFR and severity of arterial stiffness using brachial-ankle pulse wave velocity (baPWV) in 647 adult Japanese patients. baPWV correlated significantly and positively with age, hypertension, diabetes, prior cardiovascular disease, blood pressure, pulse pressure and heart rate, and negatively with eGFR (r=−0.405, p<0.0001). A multiple regression analysis revealed that baPWV correlated independently with eGFR. Furthermore, there was a stepwise increase in baPWV, corresponding to advances in CKD through stages 1 to 5. When CKD stage 3 was divided at eGFR 45 mL/min/1.73 m2, the baPWV of stage 3b (eGFR 30 to 44) was significantly higher than that of stage 3a (eGFR 45 to 59) independent of traditional risk factors, suggesting that an eGFR of 45 mL/min/1.73 m2 may be a critical cut off value to predict arterial stiffness in CKD. In conclusion, the newly proposed eGFR is significantly associated with arterial stiffness, independent of traditional risk factors for cardiovascular disease.
Sarnak MJ, Levey AS, Schoolwerth AC, et al, American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention: Kidney disease as a risk factor for development of cardiovascular disease : 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.
Anavekar NS, McMurray JJ, Velazquez EJ, et al: Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med 2004; 351: 1285–1295.
Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS : Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis 2003; 41: 1–12.
Mann JF, Gerstein HC, Yi QL, et al: Development of renal disease in people at high cardiovascular risk: results of the HOPE randomized study. J Am Soc Nephrol 2003; 14: 641–647.
Muntner P, He J, Astor BC, Folsom AR, Coresh J : Traditional and nontraditional risk factors predict coronary heart disease in chronic kidney disease: results from the atherosclerosis risk in communities study. J Am Soc Nephrol 2005; 16: 529–538.
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY : Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004; 351: 1296–1305.
Levey AS, Beto JA, Coronado BE, et al: Controlling the epidemic of cardiovascular disease in chronic renal disease: what do we know? What do we need to learn? Where do we go from here? National Kidney Foundation Task Force on Cardiovascular Disease. Am J Kidney Dis 1998; 32: 853–906.
National Kidney Foundation : K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification. Am J Kidney Dis 2002; 39 ( Suppl 1): S1–S266.
Lehmann ED : Clinical value of aortic pulse-wave velocity measurement. Lancet 1999; 354: 528–529.
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.
Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM : Impact of aortic stiffness on survival in end-stage renal disease. Circulation 1999; 99: 2434–2439.
Shoji T, Emoto M, Shinohara K, et al: Diabetes mellitus, aortic stiffness, and cardiovascular mortality in end-stage renal disease. J Am Soc Nephrol 2001; 12: 2117–2124.
Munakata M, Nunokawa T, Yoshinaga K, Toyota T : Brachial-ankle pulse wave velocity is an independent risk factor for microalbuminuria in patients with essential hypertension—a Japanese Trial on the Prognostic Implication of Pulse Wave Velocity (J-TOPP). Hypertens Res 2006; 29: 515–521.
Saijo Y, Yoshioka E, Fukui T, et al: Metabolic syndrome, C-reactive protein and increased arterial stiffness in Japanese subjects. Hypertens Res 2006; 29: 589–596.
Wang MC, Tsai WC, Chen JY, Huang JJ : Stepwise increase in arterial stiffness corresponding with the stages of chronic kidney disease. Am J Kidney Dis 2005; 45: 494–501.
Briet M, Bozec E, Laurent S, et al: Arterial stiffness and enlargement in mild-to-moderate chronic kidney disease. Kidney Int 2006; 69: 350–357.
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.
Imai E, Horio M, Nitta K, et al: Estimation of glomerular filtration rate by the MDRD study equation modified for Japanese patients with chronic kidney disease. Clin Exp Nephrol 2007; 11: 41–50.
Horio M, Orita Y : Comparison of Jaffe rate assay and enzymatic method for the measurement of creatinine clearance. Jpn J Nephrol 1996; 38: 296–299.
Coresh J, Astor BC, McQuillan G, et al: Calibration and random variation of the serum creatinine assay as critical elements of using equations to estimate glomerular filtration rate. Am J Kidney Dis 2002; 39: 920–929.
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D : A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999; 130: 461–470.
Brosius FC 3rd, Hostetter TH, Kelepouris E, et al: Detection of chronic kidney disease in patients with or at increased risk of cardiovascular disease: a science advisory from the American Heart Association Kidney and Cardiovascular Disease Council; the Councils on High Blood Pressure Research, Cardiovascular Disease in the Young, and Epidemiology and Prevention; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: developed in collaboration with the National Kidney Foundation. Circulation 2006; 114: 1083–1087.
Nakamura K, Okamura T, Hayakawa T, et al: Chronic kidney disease is a risk factor for cardiovascular death in a community-based population in Japan: NIPPON DATA90. Circ J 2006; 70: 954–959.
Yamashina A, Tomiyama H, Arai T, et al: Nomogram of the relation of brachial-ankle pulse wave velocity with blood pressure. Hypertens Res 2003; 26: 801–806.
Safar ME, London GM, Plante GE : Arterial stiffness and kidney function. Hypertension 2004; 43: 163–168.
London GM, Marchais SJ, Guerin AP, Metivier F, Adda H, Pannier B : Inflammation, arteriosclerosis, and cardiovascular therapy in hemodialysis patients. Kidney Int Suppl 2003; 84: S88–S93.
Tycho Vuurmans JL, Boer WH, Bos WJ, Blankestijn PJ, Koomans HA : Contribution of volume overload and angiotensin II to the increased pulse wave velocity of hemodialysis patients. J Am Soc Nephrol 2002; 13: 177–183.
Fliser D, Kronenberg F, Kielstein JT, et al: Asymmetric dimethylarginine and progression of chronic kidney disease: the mild to moderate kidney disease study. J Am Soc Nephrol 2005; 16: 2456–2461.
Silverberg D : Outcomes of anaemia management in renal insufficiency and cardiac disease. Nephrol Dial Transplant 2003; 18 ( Suppl 2): ii7–ii12.
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Nakagawa, N., Takahashi, F., Chinda, J. et al. A Newly Estimated Glomerular Filtration Rate Is Independently Associated with Arterial Stiffness in Japanese Patients. Hypertens Res 31, 193–201 (2008) doi:10.1291/hypres.31.193
- chronic kidney disease
- estimated glomerular filtration rate
- arterial stiffness
- cross-sectional studies
- Japanese patients
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