Arterial Stiffness and Chronic Kidney Disease Prediction

Keywords
Arterial Stiffness; Kidney Diseases; Hypertension; Endothelium; Risk Factors

The kidney and the cardiovascular system have a functional connection, and this interaction has received increasing attention. Arterial stiffness is often associated with chronic kidney disease (CKD), and both conditions can aggravate each other, generating and increasing the risk of cardiovascular events and mortality.¹ There is a two-way path between arterial stiffness and renal dysfunction. Increased arterial stiffness and the dysfunctional endothelium activate cytokines that favors thrombotic events, and dendritic cells and lymphocytes enhance the synthesis of pro-atherogenic cytokines.² The vascular inflammation amplified by CKD stimulates vessel stiffening by proliferation of the vascular smooth muscle cells and fibrosis.²

Thus, to attempt to answer the dilemma of which came first, the study by Cândido et al.³ investigated the relationship between arterial stiffening by carotid-femoral pulse wave velocity (cfPWV) and CKD. This longitudinal study followed up 11,647 participants of the ELSA-Brasil study for 4 years. The researchers concluded that higher cfPWV increased the chances of CKD in 42% and suggested that among normotensive, non-diabetic participants, this effect was even more pronounced, indicating that arterial stiffness could be a significant risk factor for CKD independent of these conditions.

Increased PWV and central systolic blood pressure have been identified as independent predictors of future cardiovascular events and target organ lesions, such as left ventricular hypertrophy and increased microalbuminuria, and they represent the limits between cardiovascular risk factors and cardiovascular events.⁴ The Systolic Blood Pressure Intervention Trial (SPRINT) concluded that systolic blood pressure < 120mmHg was not able to reduce CKD progression, but it reduced cardiovascular risk and mortality in adults without diabetes,⁵ showing the multifactorial nature of CKD progression. The CRIC study showed that PWV was highly associated with prevalent cardiovascular disease and this association was independent of systolic blood pressure.⁶ The Framingham Heart Study evaluated 7,283 subjects for 15 years, found that a standard deviation increment in cfPWV was associated with increased risk of CKD (1.19, 95% confidence interval 1.05 to 1.34),⁷ showing a similar result to other longitudinal studies.⁸,⁹

Current evidence indicates accelerated arterial stiffening in children with CKD, but there is no exact explanation for its mechanisms and consequences.¹⁰ There is a relationship aligned with increasing cardiovascular risk and left ventricular structural abnormalities.¹¹,¹² There are multiple reasons for this process, including high blood pressure, activation of the renin-angiotensin system, alterations in the vascular extracellular matrix, advanced glycation end products, oxidative stress, endothelial dysfunction, vascular calcification, and metabolic bone and mineral disorders.¹¹,¹² Clearly, CKD and increased PWV are closely interconnected and can influence each other in a bidirectional manner.¹³

Therefore, the reciprocal relationship between increased arterial stiffness and CKD underscores the intricate interplay among renal and cardiovascular health. Monitoring PWV, along with other cardiovascular classical risk factors, can be important in identifying individuals at higher risk of developing CKD and other related conditions. Early detection and management of arterial stiffness are significant in preventing the progression of cardiovascular diseases and their complications. These markers and predictors can help healthcare professionals evaluate and manage cardiovascular health effectively.

• Short Editorial related to the article: Higher Arterial Stiffness Predicts Chronic Kidney Disease in Adults: The ELSA-Brasil Cohort Study

Referências

• ¹
  Voicehovska JG, Bormane E, Grigane A, Moisejevs G, Moreino E, Trumpika D, et al. Association of Arterial Stiffness with Chronic Kidney Disease Progression and Mortality. Heart Lung Circ. 2021;30(11):1694-701. doi: 10.1016/j.hlc.2021.08.011.
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• ²
  Inserra F, Forcada P, Castellaro A, Castellaro C. Chronic Kidney Disease and Arterial Stiffness: a Two-Way Path. Front Med. 2021;8:765924. doi: 10.3389/fmed.2021.765924.
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• ³
  Cândido J, Camelo LV, Brant L, Cunha RS, Mill JG, Barreto SM. Higher Arterial Stiffness Predicts Chronic Kidney Disease in Adults: The ELSA-Brasil Cohort Study. Arq Bras Cardiol. 2023; 120(12):e20230409. DOI: https://doi.org/10.36660/abc.20230409
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  Oliveira AC, Cunha PMGM, Vitorino PVO, Souza ALL, Deus GD, Feitosa A, et al. Vascular Aging and Arterial Stiffness. Arq Bras Cardiol. 2022;119(4):604-15. doi: 10.36660/abc.20210708.
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  Cheung AK, Rahman M, Reboussin DM, Craven TE, Greene T, Kimmel PL, et al. Effects of Intensive BP Control in CKD. J Am Soc Nephrol. 2017;28(9):2812-23. doi: 10.1681/ASN.2017020148.
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  Townsend RR. Arterial Stiffness and Chronic Kidney Disease: Lessons from the Chronic Renal Insufficiency Cohort Study. Curr Opin Nephrol Hypertens. 2015;24(1):47-53. doi: 10.1097/MNH.0000000000000086.
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  Vasan RS, Pan S, Xanthakis V, Beiser A, Larson MG, Seshadri S, et al. Arterial Stiffness and Long-Term Risk of Health Outcomes: the Framingham Heart Study. Hypertension. 2022;79(5):1045-56. doi: 10.1161/HYPERTENSIONAHA.121.18776.
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  Ford ML, Tomlinson LA, Chapman TP, Rajkumar C, Holt SG. Aortic Stiffness is Independently Associated with Rate of Renal Function Decline in Chronic Kidney Disease Stages 3 and 4. Hypertension. 2010;55(5):1110-5. doi: 10.1161/HYPERTENSIONAHA.109.143024.
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  Itano S, Yano Y, Nagasu H, Tomiyama H, Kanegae H, Makino H, et al. Association of Arterial Stiffness with Kidney Function Among Adults without Chronic Kidney Disease. Am J Hypertens. 2020;33(11):1003-10. doi: 10.1093/ajh/hpaa097.
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• ¹⁰
  Azukaitis K, Jankauskiene A, Schaefer F, Shroff R. Pathophysiology and Consequences of Arterial Stiffness in Children with Chronic Kidney Disease. Pediatr Nephrol. 2021;36(7):1683-95. doi: 10.1007/s00467-020-04732-y.
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• ¹¹
  Moody WE, Edwards NC, Chue CD, Ferro CJ, Townend JN. Arterial Disease in Chronic Kidney Disease. Heart. 2013;99(6):365-72. doi: 10.1136/heartjnl-2012-302818.
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• ¹²
  Chue CD, Townend JN, Steeds RP, Ferro CJ. Arterial Stiffness in Chronic Kidney Disease: Causes and Consequences. Heart. 2010;96(11):817-23. doi: 10.1136/hrt.2009.184879.
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• ¹³
  Lioufas N, Hawley CM, Cameron JD, Toussaint ND. Chronic Kidney Disease and Pulse Wave Velocity: A Narrative Review. Int J Hypertens. 2019;2019:9189362. doi: 10.1155/2019/9189362.
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Publication Dates

• Publication in this collection
  04 Mar 2024
• Date of issue
  2023

History

• Received
  09 Nov 2023
• Reviewed
  06 Dec 2023
• Accepted
  06 Dec 2023