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Large Artery Stiffening and Remodeling Are Independently Associated With All-Cause Mortality and Cardiovascular Events in Chronic Kidney Disease

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 sti... Full description

Journal Title: Hypertension (Dallas Tex. 1979), 2012-12, Vol.60 (6), p.1451-1457
Main Author: Karras, Alexandre
Other Authors: Haymann, Jean-Philippe , Bozec, Erwan , Metzger, Marie , Jacquot, Christian , Maruani, Gerard , Houillier, Pascal , Froissart, Marc , Stengel, Bénédicte , Guardiola, Philippe , Laurent, Stéphane , Boutouyrie, Pierre , Briet, Marie
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: Hagerstown, MD: American Heart Association, Inc
ID: ISSN: 0194-911X
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recordid: cdi_hal_primary_oai_HAL_hal_03388060v1
title: Large Artery Stiffening and Remodeling Are Independently Associated With All-Cause Mortality and Cardiovascular Events in Chronic Kidney Disease
format: Article
creator:
  • Karras, Alexandre
  • Haymann, Jean-Philippe
  • Bozec, Erwan
  • Metzger, Marie
  • Jacquot, Christian
  • Maruani, Gerard
  • Houillier, Pascal
  • Froissart, Marc
  • Stengel, Bénédicte
  • Guardiola, Philippe
  • Laurent, Stéphane
  • Boutouyrie, Pierre
  • Briet, Marie
subjects:
  • Adult
  • Aged
  • Arterial hypertension. Arterial hypotension
  • Biological and medical sciences
  • Blood and lymphatic vessels
  • Blood Pressure - physiology
  • Cardiology. Vascular system
  • Cardiovascular Diseases - complications
  • Cardiovascular Diseases - mortality
  • Cardiovascular Diseases - physiopathology
  • Carotid Artery Diseases - complications
  • Carotid Artery Diseases - mortality
  • Carotid Artery Diseases - physiopathology
  • Carotid Intima-Media Thickness
  • Clinical manifestations. Epidemiology. Investigative techniques. Etiology
  • Female
  • Glomerular Filtration Rate - physiology
  • Humans
  • Life Sciences
  • Male
  • Medical sciences
  • Middle Aged
  • Prognosis
  • Renal Insufficiency, Chronic - complications
  • Renal Insufficiency, Chronic - mortality
  • Renal Insufficiency, Chronic - physiopathology
  • Survival Rate
  • Vascular Stiffness - physiology
ispartof: Hypertension (Dallas, Tex. 1979), 2012-12, Vol.60 (6), p.1451-1457
description: 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. 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.
language: eng
source:
identifier: ISSN: 0194-911X
fulltext: no_fulltext
issn:
  • 0194-911X
  • 1524-4563
  • 1524-4563
url: Link


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titleLarge Artery Stiffening and Remodeling Are Independently Associated With All-Cause Mortality and Cardiovascular Events in Chronic Kidney Disease
creatorKarras, Alexandre ; Haymann, Jean-Philippe ; Bozec, Erwan ; Metzger, Marie ; Jacquot, Christian ; Maruani, Gerard ; Houillier, Pascal ; Froissart, Marc ; Stengel, Bénédicte ; Guardiola, Philippe ; Laurent, Stéphane ; Boutouyrie, Pierre ; Briet, Marie
creatorcontribKarras, Alexandre ; Haymann, Jean-Philippe ; Bozec, Erwan ; Metzger, Marie ; Jacquot, Christian ; Maruani, Gerard ; Houillier, Pascal ; Froissart, Marc ; Stengel, Bénédicte ; Guardiola, Philippe ; Laurent, Stéphane ; Boutouyrie, Pierre ; Briet, Marie ; Nephro Test Study Group
descriptionChronic 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. 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.
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subjectAdult ; Aged ; Arterial hypertension. Arterial hypotension ; Biological and medical sciences ; Blood and lymphatic vessels ; Blood Pressure - physiology ; Cardiology. Vascular system ; Cardiovascular Diseases - complications ; Cardiovascular Diseases - mortality ; Cardiovascular Diseases - physiopathology ; Carotid Artery Diseases - complications ; Carotid Artery Diseases - mortality ; Carotid Artery Diseases - physiopathology ; Carotid Intima-Media Thickness ; Clinical manifestations. Epidemiology. Investigative techniques. Etiology ; Female ; Glomerular Filtration Rate - physiology ; Humans ; Life Sciences ; Male ; Medical sciences ; Middle Aged ; Prognosis ; Renal Insufficiency, Chronic - complications ; Renal Insufficiency, Chronic - mortality ; Renal Insufficiency, Chronic - physiopathology ; Survival Rate ; Vascular Stiffness - physiology
ispartofHypertension (Dallas, Tex. 1979), 2012-12, Vol.60 (6), p.1451-1457
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7Froissart, Marc
8Stengel, Bénédicte
9Guardiola, Philippe
10Laurent, Stéphane
11Boutouyrie, Pierre
12Briet, Marie
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0Large Artery Stiffening and Remodeling Are Independently Associated With All-Cause Mortality and Cardiovascular Events in Chronic Kidney Disease
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descriptionChronic 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. 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.
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4Blood and lymphatic vessels
5Blood Pressure - physiology
6Cardiology. Vascular system
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11Carotid Artery Diseases - mortality
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13Carotid Intima-Media Thickness
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16Glomerular Filtration Rate - physiology
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22Prognosis
23Renal Insufficiency, Chronic - complications
24Renal Insufficiency, Chronic - mortality
25Renal Insufficiency, Chronic - physiopathology
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titleLarge Artery Stiffening and Remodeling Are Independently Associated With All-Cause Mortality and Cardiovascular Events in Chronic Kidney Disease
authorKarras, Alexandre ; Haymann, Jean-Philippe ; Bozec, Erwan ; Metzger, Marie ; Jacquot, Christian ; Maruani, Gerard ; Houillier, Pascal ; Froissart, Marc ; Stengel, Bénédicte ; Guardiola, Philippe ; Laurent, Stéphane ; Boutouyrie, Pierre ; Briet, Marie
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7Cardiovascular Diseases - complications
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9Cardiovascular Diseases - physiopathology
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25Renal Insufficiency, Chronic - physiopathology
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abstractChronic 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. 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.
copHagerstown, MD
pubAmerican Heart Association, Inc
pmid23090769
doi10.1161/HYPERTENSIONAHA.112.197210
oafree_for_read