Hemodynamic correlates of proteinuria in chronic kidney disease

Matthew R Weir, Raymond R Townsend, Jeffrey C Fink, Valerie Teal, Cheryl Anderson, Lawrence Appel, Jing Chen, Jiang He, Natasha Litbarg, Akinlolu Ojo, Mahboob Rahman, Leigh Rosen, Stephen M Sozio, Susan Steigerwalt, Louise Strauss, Marshall M Joffe, Matthew R Weir, Raymond R Townsend, Jeffrey C Fink, Valerie Teal, Cheryl Anderson, Lawrence Appel, Jing Chen, Jiang He, Natasha Litbarg, Akinlolu Ojo, Mahboob Rahman, Leigh Rosen, Stephen M Sozio, Susan Steigerwalt, Louise Strauss, Marshall M Joffe

Abstract

Background and objectives: Brachial artery measures of BP are associated with increasing degrees of proteinuria. Whether central measures of BP or vascular stiffness are associated with increased risk of proteinuria in patients with chronic kidney disease (CKD) is unknown.

Design, setting, participants, & measurements: Measurements of central and brachial artery BP, and aortic pulse wave velocity (PWV) were performed in a cross-sectional cohort of patients with CKD (n = 2144) from the Chronic Renal Insufficiency Cohort (CRIC) study to determine factors which predict increased risk of proteinuria. Multivariate analysis stratified by diabetes included age, ethnicity, gender, estimated glomerular filtration rate (GFR), waistline, smoking, heart rate, and medications to evaluate the relationship of hemodynamic factors and proteinuria.

Results: Brachial artery systolic BP (SBP) was important as an explanatory factor for variations in proteinuria among both diabetics (R(2) = 0.40, P < 0.0001) and non diabetics (R(2) = 0.38, P < 0.001). Measures of peripheral pulse pressure (PP), central SBP, and central pulse pressure added little to the explained variation in proteinuria beyond brachial artery SBP, whereas PWV as a measure of vascular stiffness incrementally accounted for a significant portion of variation in proteinuria beyond that explained by brachial artery SBP in diabetics (R(2) = 0.42, P < 0.001) but not non diabetics.

Conclusions: Brachial artery SBP and PWV are both associated with variations in proteinuria in patients with CKD.

Figures

Figure 1.
Figure 1.
This scatterplot matrix figure (n = 2122) illustrates the relationship (Pearson correlation coefficient, P value) between (A) central systolic BP (CSBP) mmHg and peripheral systolic BP (SBP) mmHg (0.97, P < 0.0001); (B) peripheral pulse pressure (PP) mmHg and CSBP mmHg (0.74, P < 0.0001); (C) central pulse pressure (CPP) mmHg and SBP mmHg (0.78, P < 0.0001); and (D) CPP mmHg and PP mmHg (0.95, P < 0.0001).

Source: PubMed

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