Association of aortic stiffness with abdominal vascular and coronary calcifications in patients with stage 3 and 4 chronic kidney disease

Abstract

Rationale and objectives: Increased central (aortic) arterial stiffness has hemodynamic repercussions that affect the incidence of cardiovascular and renal disease. In chronic kidney disease (CKD) there may be an increase in aortic stiffness secondary to multiple metabolic alterations including calcification of the vascular wall (VC). The objective of this study was to analyze the association of central aortic pressures and aortic stiffness with the presence of VC in abdominal aorta (AAC) and coronary arteries(CAC).

Materials and methods: We included 87 pacientes with CKD stage 3 and 4. Using applanation tonometry, central aortic pressures and aortic stiffness were studied. We investigated the association of aortic pulse wave velocity (Pv_c-f) and Pv_c-f adjusted for age, blood pressure, sex and heart rate (Pv_c-f index) with AAC obtained on lumbar lateral radiography and CAC assessed by multidetector computed tomography. AAC and CAC were scored according to Kauppila and Agatston methods, respecti-vely. For the study of the association between Pv_c-f index, Kauppila score, Agatston score, central aortic pressures, clinical parameters and laboratory data, multiple and logistic regression were used. We investigated the diagnosis performance of the Pv_c-f index for prediction of VC using receiver-operating characteristic (ROC).

Results: Pv_c-f and Pv_c-f index were 11.3 ± 2.6 and 10.6 m/s, respectively. The Pv_c-f index was higher when CKD coexisted with diabetes mellitus (DM). AAC and CAC were detected in 77% and 87%, respectively. Albuminuria (β = 0.13, p = 0.005) and Kauppila score (β = 0.36, p = 0.001) were independently associated with Pv_c-f index. In turn, Pv_c-f index (β = 0.39, p = 0.001), DM (β = 0.46, p = 0.01), and smoking (β = 0.53; p = 0.006) were associated with Kauppila score, but only Pv_c-f index predicted AAC [OR: 3.33 (95% CI: 1.6-6.9; p = 0.001)]. The Kauppila score was independently associated with the Agatston score (β = 1.53, p = 0.001). The presence of AAC identified patients with CAC with a sensitivity of 73%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 38%. The Vp_c-f index predicted the presence of CAC [OR: 3.35 (95% CI: 1.04-10.2, p = 0.04)]. In the ROC curves, using the Vp_c-f index, the AUC for AAC and CAC was 0.82 (95%CI: 0.71-0.93, p = 0.001) and 0.81 (95% CI: 0.67-0.96, p = 0.02), respectively.

Conclusions: When stage 3-4 CKD coexists with DM there is an increase in aortic stiffness determined by the Vp_c-f index. In stage 3-4 CKD, AAC and CAC are very prevalent and both often coexist. The Vp_c-f index is independently associated with AAC and CAC and may be useful in identifying patients with VC in these territories.

Keywords: Agatston score; Aortic stiffness; Calcificaciones vasculares; Chronic kidney disease; Enfermedad renal crónica; Kauppila score; Pulse velocity; Rigidez aórtica; Vascular calcifications; Velocidad de pulso; Índice de Agatston; Índice de Kauppila.