Higher Arterial Stiffness Predicts Chronic Kidney Disease in Adults: The ELSA-Brasil Cohort Study

Cândido, Júlia; Camelo, Lidyane do Valle; Brant, Luisa; Cunha, Roberto Sá; Mill, José Geraldo; Barreto, Sandhi Maria

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Original Article • Arq. Bras. Cardiol. 120 (12) • 2023 • https://doi.org/10.36660/abc.20230409 copy

Higher Arterial Stiffness Predicts Chronic Kidney Disease in Adults: The ELSA-Brasil Cohort Study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Central Illustration
: Higher Arterial Stiffness Predicts Chronic Kidney Disease in Adults: The ELSA-Brasil Cohort Study

Abstract

Background

Arterial stiffening can directly affect the kidneys, which are passively perfused by a high flow. However, whether the relation between arterial stiffness and renal function depends on diabetes and hypertension conditions, is a matter of debate.

Objective

To investigate the relationship between arterial stiffening by carotid-to-femoral pulse wave velocity (cfPWV) and chronic kidney disease (CKD) incidence in individuals and verify whether this association is present in individuals without hypertension and diabetes.

Methods

A longitudinal study of 11,647 participants of the ELSA-Brasil followed up for four years (2008/10-2012/14). Baseline cfPWV was grouped per quartile, according to sex-specific cut-offs. Presence of CKD was ascertained by glomerular filtration rate (eGFR-CKD-EPI) < 60 ml/min/1.73 m² and/or albumin-to-creatinine ratio ≥ 30 mg/g. Logistic regression models were run for the whole cohort and a subsample free from hypertension and diabetes at baseline, after adjustment for age, sex, race, schooling, smoking, cholesterol/HDL ratio, body mass index, diabetes, use of antihypertensive, systolic blood pressure, heart rate, and cardiovascular disease. Statistical significance was set at 5%.

Results

The chance of CKD was 42% (CI 95%: 1.05;1.92) greater among individuals in the upper quartile of cfPWV. Among normotensive, non-diabetic participants, individuals in the 2^nd, 3^rd, and 4^th quartiles of cfPWV presented greater chances of developing CKD, as compared to those in the lower quartile, and the magnitude of this association was the greatest for those in the upper quartile (OR: 1.81 CI 95%: 1.14;2.86).

Conclusion

Higher cfPWV increased the chances of CKD and suggests that this effect is even greater in individuals without diabetes and hypertension.

Chronic Kidney Disease; Arterial Stiffness; Glomerular Filtration Rate

Characteristics	% or mean (SD)
%, mean (SD)	General population	Normotensive, non-diabetic participants
%, mean (SD)	N: 11,647	N: 7,309
Age (years), mean (SD)	51 (8)	49 (8)
Sex, (%)
Female	54.8	58
Race/color, (%)
White	53.3	57
Brown	27.7	27.3
Black	15.4	12.2
Other	3.5	3.4
Education, (%)
Undergraduate studies	54.9	59.5
High school graduate	34.6	32.6
Middle school	5.9	4.8
Middle school dropout	4.5	2.9
Diabetes mellitus, (%)	12.7	-
Hypertension, (%)	30.3	-
Use of antihypertensive, (%)	24.2	-
Heart rate (bpm), mean (SD)	70 (10)	69 (9)
Systolic blood pressure (mmHg), mean (SD)	120 (16)	113 (11)
Diastolic blood pressure (mmHg), mean (SD)	76 (10)	72 (8)
cfPWV (m/s) mean (SD)	9.1 (1.6)	8.6 (1.3)

Characteristics	Incidence (%)
Characteristics	General population	Normotensive, non-diabetic participants
Total	5.6	3.2
Age (years)
34-44	2.0	1.3
45-54	4.0	2.9
55-64	7.4	5.8
65-75	19.6	13.3
Sex
Female	5.2	2.7
Male	5.3	3.5
Race/color, (%)
White	5.0	3.0
Brown	4.6	3.2
Black	7.1	4.2
Other	4.3	2.8
Education, (%)
Undergraduate studies	4.6	2.9
High school graduate	5.3	3.1
Middle school	7.8	4.9
Middle school dropout	7.5	5.6
Diabetes mellitus		-
Yes	12.7
No	4.5
Hypertension		-
Yes	9.5
No	3.7
Use of antihypertensive		-
Yes	10
No	4.1

Models	Chronic Kidney Disease (N:11,647) OR (CI 95%)
Univariate model
1^st quartile	Ref
2^nd quartile	1.74 (1.31;2,31)***
3^rd quartile	2.16 (1.64;2.83)***
4^th quartile	4.14 (3.22;5.33)***
Model 1: model 0 + age, sex, race/color, and education
1^st quartile	Ref
2^nd quartile	1.46 (1.09;1.94)*
3^rd quartile	1.50 (1.13;1.99)**
4^th quartile	1.94 (1.47;2.55)***
Model 2: model 1 + smoking, physical activity, total cholesterol/HDL-C and BMI
1^st quartile	Ref
2^nd quartile	1.39 (1.04;1.86)*
3^rd quartile	1.42 (1.06;1.88)*
4^th quartile	1.79 (1.36; 2.37)***
Final model: model 3 + DM, Use of antihypertensive, SBP, HR and CVD
1^st quartile	Ref
2^nd quartile	1.32 (0.98;1.78)
3^rd quartile	1.31 (0.98; 1.76)
4^th quartile	1.42 (1.05;1.92)*

Models	Chronic Kidney Disease (N:7,189) OR (CI 95%)
Univariate model
1^st quartile	Ref
2^nd quartile	1.99 (1.35;2.94)***
3^rd quartile	2.39 (1.62;3.62)***
4^th quartile	3.49 (2.35;5.20)***
Model 1: model 0 + age, sex, race/color, and education
1^st quartile	Ref
2^nd quartile	1.66 (1.12;2.46)*
3^rd quartile	1.65 (1.17;2.47)*
4^th quartile	1.79 (1.17;2.74)**
Model 2: model 1 + smoking, physical activity, total cholesterol/HDL-C and BMI
1^st quartile	Ref
2^nd quartile	1.58 (1.06;2.35)*
3^rd quartile	1.61 (1.07;2.41)*
4^th quartile	1.76 (1.14;2.70)**
Final model: model 3 + SBP, HR and CVD
1^st quartile	Ref
2^nd quartile	1.61 (1.08;2.41)*
3^rd quartile	1.63 (1.07;2.47)*
4^th quartile	1.81 (1.14;2.86)*

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