Prevalence of Arterial Stiffness and Associated Factors in Thai Patients with Chronic Kidney Disease and Kidney Transplant Recipients
Prasert Thanakitcharu MD*, Yanasar Jitsuparat MD*, Boonthum Jirajan MD*
Affiliation : * Division of Nephrology, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
Background : Patients with chronic kidney disease (CKD), end-stage renal disease (ESRD) with dialysis, and kidney transplant
(KT) recipients are associated with increased cardiovascular (CV) morbidity and mortality. Arterial stiffness is a major non-
traditional risk factor of CV disease, and increased aortic pulse wave velocity (PWV), the gold standard for arterial stiffness
assessment, may predict CV morbidity and mortality in these patients.
Objective : The purpose of the present study was to evaluate the prevalence of arterial stiffness in pre-dialysis CKD, ESRD
with dialysis patients and KT recipients, and associated factors that exacerbate the condition in order to serve as evidence to
search for appropriate therapeutic options.
Material and Method: This was a cross-sectional study of 169 patients including cases of pre-dialysis CKD stages 3-5,
ESRD with hemodialysis (HD), continuous ambulatory peritoneal dialysis (CAPD), kidney transplant (KT) recipients and
healthy volunteers. Central blood pressure (BP) and aortic PWV were assessed using the SphygmoCor® CPV Pulse Wave
Velocity system (AtCor Medical, Sydney, Australia). Increased arterial stiffness was defined as aortic PWV of >12 m/s.
Results : The prevalence rates of arterial stiffness in pre-dialysis CKD, HD, CAPD patients, KT recipients and normal
controls were 53.1%, 68.8%, 64.7%, 38.9% and 5.7% respectively, and the mean aortic PWVs were 12.7+2.2, 13.5+2.8,
13.4+2.8, 11.3+1.8 and 9.5+1.7 m/s respectively (p<0.001). The factors associated with arterial stiffness determined by
univariate analysis were older age, diabetes, CKD, HD, CAPD, KT recipients, higher brachial and central BP, higher serum
phosphate, and calcium-phosphate products. A multivariate model showed that only HD, KT recipients, older age and higher
central mean arterial pressure (MAP) were independently associated with increased arterial stiffness, with adjusted odds
ratio (95% confidence interval) of 17.71 (2.39-131.04), 9.29 (1.46-59.09), 1.09 (1.05-1.14), and 1.11 (1.06-1.16) respectively.
Conclusion : Arterial stiffness was markedly raised in all groups of CKD patients with an overall prevalence of 56%. The
highest prevalence of arterial stiffness was found in ESRD patients treated with HD and CAPD. It was shown that the
associated factors that independently increased arterial stiffness were HD patients, KT recipients, older age and higher
central MAP.
Keywords : Arterial stiffness, Cardiovascular disease, Pulse wave velocity, Chronic kidney disease, End stage renal disease, Dialysis, Kidney transplantation
