Greater aortic stiffness is associated with renal dysfunction in participants of the ELSA-Brasil cohort with and without hypertension and diabetes

Abstract

Background Arterial stiffness has been associated with renal dysfunction and its progression, but the pathophysiological relation underlying this association has not been fully established, particularly among individuals without hypertension and diabetes. We investigated the cross-sectional associations between arterial stiffness and renal function in adults without cardiovascular disease, and whether this association remained among subjects without hypertension and diabetes. Methods All eligible participants from ELSA-Brasil (2008-2010), aged 35 to 74 years (N = 13,586) were included, of whom 7,979 were free from hypertension and diabetes. The response variables were: 1) low glomerular filtration rate (eGFR<60m1/min/1.73m(2)) estimated by CKD-EPI; 2) increased albumin/creatinine ratio (ACR >= 30mg/g); and 3) chronic kidney disease (CKD). Arterial stiffness was ascertained by the carotid-femoral pulse wave velocity (PWV). The covariates were sex, age, race/color, level of schooling, smoking, body mass index, total cholesterol/HDL-c glycated hemoglobin, diabetes, systolic blood pressure, heart rate and use of antihypertensive drugs. Logistic regression was used to examine the associations. Results After all adjustments, 1 m/s increase in PWV was associated with ORs equal to 1.10 (95% CI: 1.04-1.16), 1.10 (95%Cl: 1.05-1.16) and 1.12 (95%Cl: 1.08-1.17) of low eGFR, high ACR, and CKD, respectively. In subjects without hypertension and diabetes, these ORs were 1.19 (95%Cl: 1.07-1.33), 1.20 (95%Cl: 1.07-1.32) and 1.21 (95%Cl: 1.11-1.30), respectively. Conclusion The increase in PWV was associated with all renal dysfunction markers, even in individuals without hypertension and diabetes, suggesting a relation that is not completely mediated by the presence of these conditions.