期刊
HYPERTENSION
卷 60, 期 6, 页码 1451-U222出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/HYPERTENSIONAHA.112.197210
关键词
renal insufficiency; remodeling; carotid artery common; aortic stiffness; mortality
资金
- French Ministry of Health [AOM 09114]
- Delegation a la Recherche Clinique
- Assistance Publique-Hopitaux de Paris
- Programme Hospitalier de Recherche Clinique [AOM 03023P030439]
- French Ministry of Research [01 P 0512]
- Inserm [AO 8022LS, GIS-IReSP AO 8113LS TGIR]
- Agence de Biomedecine [R08156LL/RP018156LLA]
- Roche [2009-152-447G]
- Association pour l'Utilisation du Rein Artificiel, AURA, Paris
- Affymax
- Genzyme
- Hoffmann-La Roche
- Novartis
- Sandoz
- Shire
- Takeda
- Vifor International
- Otsuka Ltd.
- Roche
Chronic kidney disease, even at moderate stages, is characterized by a high incidence of cardiovascular events. Subclinical damage to large arteries, such as increased arterial stiffness and outward remodeling, is a classical hallmark of patients with chronic kidney disease. Whether large artery stiffness and remodeling influence the occurrence of cardiovascular events and the mortality of patients with chronic kidney disease (stages 2-5) is still debated. This prospective study included 439 patients with chronic kidney disease (mean age, 59.8 +/- 14.5 years) with a mean measured glomerular filtration rate of 37 mL/min per 1.73 m(2). Baseline aortic stiffness was estimated through carotid-femoral pulse wave velocity measurements; carotid stiffness, diameter, and intima-media thickness were measured with a high-resolution echotracking system. For the overall group of patients, the 5-year estimated survival and cumulative incidence of cardiovascular events were 87% and 16%, respectively. In regression analyses adjusted on classical cardiovascular and renal risk factors, aortic stiffness remained significantly associated with all-cause mortality (for 1 SD, Cox model-derived relative risk [95% CI], 1.48 [1.09-2.02]) and with fatal and nonfatal cardiovascular events (for 1 SD, Fine and Gray competing risks model-derived relative risk [95% CI], 1.35 [1.05-1.75]). Net reclassification improvement index was significant (29.0% [2.3-42.0%]). Carotid internal diameter was also independently associated with all-cause mortality. This study shows that increased aortic stiffness and carotid internal diameter are independent predictors of mortality in patients with stages 2 to 5 chronic kidney disease and that aortic stiffness improves the prediction of the risk. (Hypertension. 2012;60:1451-1457.)
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