Association of arterial rigidity with incident kidney disease and kidney function decline: The health ABC study

Background and objective The association of large arterial rigidity and kidney function decline in longitudinal analyses is not well established. This study evaluated the association of aortic pulse wave velocity (aPWV) and pulse pressure (PP) with rapid kidney function decline and incident CKD in the Health, Aging and Body Composition study. Design, setting, participants, & measurements Participants were 2129 older adults with a baseline measurement of aPWV, PP, and cystatin C and at least one additional measurement of cystatin C, either at year 3 or year 10. Outcomes were rapid kidney function decline (estimated GFR_cysC loss of >3 ml/min per 1.73 m² per year) and incident CKD (eGFR_cysC < 60 ml/min per 1.73 m² in participants with baseline estimated GFR > 60 ml/min per 1.73 m²). Multivariate regression models were used to evaluate association of aPWV and PP with each outcome. Results Mean (SD) baseline estimated GFR_cysC was 79±29 ml/min per 1.73 m². Median follow-up duration was 8.9 years. In multivariable analyses, aPWV was not associated with rapid decline (odds ratio [OR], 95% confidence interval [CI] 1.16, 0.89-1.52) but was associated with incident CKD (incident rate ratio [IRR], 95% CI, 1.39, 1.09-1.77) and PP was associated with both rapid decline (OR, 95% CI 1.10, 1.04-1.16) and incident CKD (IRR, 95% CI, 1.06, 1.01-1.11). Conclusions Large arterial stiffness assessed by aPWV and pulsatility assessed by PP were associated with incident CKD among older adults. Pulsatility assessed by PP was associated with rapid kidney function decline and incident CKD. Future research should determine whether interventions targeting arterial rigidity will prevent CKD development and progression.