Arterial Stiffness and Subsequent Incidence of CKD and Kidney Function Decline in a Large Longitudinal Community Cohort: The Atherosclerosis in Communities (ARIC) Study

Rationale & Objective

Arterial stiffness is associated with prevalent chronic kidney disease (CKD). Whether arterial stiffness is prospectively associated with incident CKD is inconclusive.

Study Design

Longitudinal cohort study.

Setting & Participants

Using data from the Atherosclerosis Risk in Communities (ARIC) Study, the primary analysis included 3,161 participants without prevalent CKD at visit 5; a secondary analysis studied 4,341 participants with any estimated glomerular filtration rate (eGFR) record across visits 5 to 7.

Exposure

Carotid-femoral pulse wave velocity (cfPWV), heart-femoral PWV (hfPWV), heart-ankle PWV (haPWV), brachial-ankle PWV (baPWV), heart-carotid PWV (hcPWV), and femoral-ankle PWV (faPWV).

Outcome

Primary analysis was incident CKD, defined as an eGFR < 60 mL/min/1.73 m² accompanied by >25% decline eGFR or CKD hospitalization. Secondary analysis was eGFR slope.

Analytical Approach

For primary analysis, Cox regression models to calculate HR. For secondary analysis, multilevel mixed effects models to estimate the eGFR slope across visits.

Results

The median follow-up period was 6.6 years, in which 460 participants developed incident CKD (incidence rate 22.0 per 1,000 person-years). The highest quartiles (Q4) of cfPWV, hfPWV, and haPWV were associated with an increased risk of incident CKD compared with the lowest quartile (Q1) (HR, 1.53 [95% CI, 1.15-2.04]; HR, 1.49 [95% CI, 1.12-1.99], and HR, 1.56 [95% CI, 1.16-2.08], respectively) (P < 0.05). The results were consistent in subgroups. In the secondary analysis, the Q4s of cfPWV, hfPWV, haPWV, baPWV, and hcPWV were significantly associated with a faster eGFR decline compared to Q1 (eg, for cfPWV, −0.44 mL/min/1.73 m²/year [95% CI, −0.56 to −0.33] in Q4 vs −0.37 [95% CI, −0.48 to −0.26] in Q1) (P < 0.05). faPWV was not associated with incident CKD or eGFR slope.

Limitations

Residual confounding.

Conclusions

Greater arterial stiffness, especially higher cfPWV, hfPWV, and haPWV, was prospectively associated with a higher risk of incident CKD and faster decline in eGFR among community-dwelling older adults, supporting a pathophysiological contribution of arterial stiffness to the development of CKD.

Plain-Language Summary

Prior studies have shown a cross-sectional correlation between greater arterial stiffness and worse kidney function. We wanted to understand whether arterial stiffness is linked to the development of kidney disease. To explore this, we studied a group of adults over several years, measuring how stiff their arteries were using different pulse wave velocities from different sites. We found that people with stiffer arteries, particularly those with higher stiffness in specific areas like the carotid and femoral arteries, were more likely to develop chronic kidney disease. They also experienced a faster decline in kidney function. This suggests that artery stiffness may play a role in worsening kidney health over time. Our findings highlight the importance of managing artery stiffness to help prevent kidney disease in older adults.