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Endothelial function, arterial stiffness and Framingham risk score in chronic kidney disease: A prospective observational cohort study

Hypertension Research volume 46, pages 868–878 (2023)Cite this article

Abstract

The aim of this study was to assess the role of endothelial function measured by the reactive hyperemia index (RHI), arterial stiffness measured by the augmentation index (AIx), and Framingham’s cardiovascular disease (CVD) risk score (FRS) in kidney function decline in patients with chronic kidney disease (CKD). The RHI and AIx@75 (adjusted for 75 heart beats per minute), both derived from peripheral arterial tonometry (EndoPAT), were measured in 428 CKD patients aged 18 years old and older during hospitalization. We evaluated kidney function and its decline (incident ≥40% decline in estimated glomerular filtration rate [eGFR] or initiation of renal replacement therapy) associated with the RHI, AIx@75, and FRS during follow-up for a median of 36 months. The mean age of the participants was 56 years old, and 63.8% were men. In Spearman correlation analysis, the FRS, AIx@75, and RHI levels inversely correlated with eGFR. Over a median follow-up of 36 months, 122 participants experienced kidney function decline. In multivariate Cox analysis, only the FRS remained independently associated with the progression of kidney function (HR, 1.37; 95% CI, 1.14 to 1.64; P = 0.001). Multivariable-adjusted spline regression models showed a positive linear relationship between the FRS and the risk of kidney function decline (P-overall = 0.001, P-nonlinear = 0.701). However, adding the FRS to a model containing kidney function markers did not improve risk prediction for kidney outcome (category-free net reclassification improvement index [cf-NRI] = 0.179, P = 0.084; integrated discrimination improvement [IDI] = 0.017, P = 0.128). Additionally, the increased risk of the outcome associated with an elevated FRS was particularly evident among CKD patients with eGFR ≥60 ml/min/1.73  m2 (eGFR ≥ 60 ml/min/1.73 m2 vs.< 60 ml/min/1.73 m2, P for interaction =  0.022). Participants with higher FRS levels were at increased risk of kidney function decline, emphasizing the important role of traditional CVD risk factors in the progression of CKD.

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Funding

This study was supported by the Natural Science Foundation of China (NSFC) (82170686), the National Key Research and Development (R&D) Program of China (2018YFA0108803), and the Science and Technology Project of Beijing, China (D181100000118004).

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Authors and Affiliations

  1. Department of Nephrology, The First Medical Centre, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, China

    Yisha Li, Xinru Guo, Shuang Liang, Ping Li, Pu Chen, Ying Zheng, Jie Wu, Xiangmei Chen & Guangyan Cai

  2. School of Medicine, Nankai University, Tianjin, China

    Xinru Guo

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  1. Yisha Li
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Contributions

GY. Cai and YS. Li contributed to the research idea and study design; YS. Li, XR. Guo and S. Liang collected the data; YS. Li and P. Chen performed the statistical analyses; YS. Li, XR. Guo, Y. Zheng, and P. Li contributed to the interpretation of the results; and GY. Cai, J. Wu and XM. Chen provided supervision or mentorship.

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Correspondence to Guangyan Cai.

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Li, Y., Guo, X., Liang, S. et al. Endothelial function, arterial stiffness and Framingham risk score in chronic kidney disease: A prospective observational cohort study. Hypertens Res 46, 868–878 (2023). https://doi.org/10.1038/s41440-022-01141-6

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