The role of pulse pressure in navigating the paradigm of chronic kidney disease progression in type 2 diabetes mellitus

Background and aims Arterial stiffness is a risk factor for chronic kidney disease progression (CKD). Pulse pressure is a surrogate marker of arterial stiffness. It is unclear if pulse pressure predicts CKD progression in type 2 diabetes mellitus. Methods This was prospective study involving 1494 pa...
Ausführliche Beschreibung

Background and aims Arterial stiffness is a risk factor for chronic kidney disease progression (CKD). Pulse pressure is a surrogate marker of arterial stiffness. It is unclear if pulse pressure predicts CKD progression in type 2 diabetes mellitus. Methods This was prospective study involving 1494 patients with estimated glomerular filtration rate (eGFR) ≥ 15 ml/min/1.73 $ m^{2} $. Carotid-femoral pulse wave velocity was measured using applanation tonometry. Pulse pressure was calculated as difference between systolic and diastolic blood pressures. CKD progression was defined as worsening of eGFR categories (stage 1, ≥ 90 ml/min/1.73 $ m^{2} $; stage 2, 60–89 ml/min/1.73 $ m^{2} $; stage 3a, 45–59 ml/min/1.73 $ m^{2} $; stage 3b, 30–44 ml/min/1.73 $ m^{2} $; stage 4; 15–29 ml/min/1.73 $ m^{2} $; and stage 5, < 15 ml/min/1.73 $ m^{2} $) with ≥ 25% decrease in eGFR from baseline. Results After follow-up of up to 6 years, CKD progression occurred in 33.5% of subjects. Subjects in 2nd, 3rd and 4th quartiles of peripheral pulse pressure experienced higher risk of CKD progression with unadjusted hazard ratios (HRs) 1.55 [95% confidence interval (CI) 1.13–2.11; p = 0.006], 2.58 (1.93–3.45; p < 0.001) and 3.41 (2.58–4.52; p < 0.001). In the fully adjusted model, the association for 2nd, 3rd and 4th quartiles remained with HRs 1.40 (1.02–1.93; p = 0.038), 1.87 (1.37–2.56; p < 0.001) and 1.75 (1.25–2.44; p = 0.001) respectively. Similarly, 2nd, 3rd and 4th quartiles of aortic pulse pressure were associated with higher hazards of CKD progression with HRs 1.73 (1.25–2.40; p = 0.001), 1.65 (1.18–2.29; p = 0.003) and 1.81 (1.26–2.60; p = 0.001). Increasing urinary albumin-to-creatinine ratio accounted for 44.0% of the association between peripheral pulse pressure and CKD progression. Conclusions Individuals with high pulse pressure were more susceptible to deterioration of renal function. Pulse pressure could potentially be incorporated in clinical practice as an inexpensive and readily available biomarker of renal decline in type 2 diabetes mellitus. Graphic abstract Ausführliche Beschreibung

Autor*in:	Low, Serena [verfasserIn] Moh, Angela [verfasserIn] Ang, Su Fen [verfasserIn] Lim, Chin Leong [verfasserIn] Liu, Yan Lun [verfasserIn] Wang, Jiexun [verfasserIn] Ang, Keven [verfasserIn] Tang, Wern Ee [verfasserIn] Kwan, Pek Yee [verfasserIn] Lim, Ziliang [verfasserIn] Subramaniam, Tavintharan [verfasserIn] Sum, Chee Fang [verfasserIn] Lim, Su Chi [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2021

Schlagwörter:	Pulse pressure Chronic kidney disease Type 2 diabetes mellitus

Anmerkung:	© Italian Society of Nephrology 2021

Übergeordnetes Werk:	Enthalten in: Journal of nephrology - Milano : Springer, 1996, 34(2021), 5 vom: 25. Jan., Seite 1429-1444
Übergeordnetes Werk:	volume:34 ; year:2021 ; number:5 ; day:25 ; month:01 ; pages:1429-1444

Links:	Volltext

DOI / URN:	10.1007/s40620-020-00954-3

Katalog-ID:	SPR045234817