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

Arterial stiffness is associated with prevalent chronic kidney disease (CKD). Whether arterial stiffness is prospectively associated with incident CKD is inconclusive. Longitudinal cohort study. 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. 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). Primary analysis - incident CKD, defined as an eGFR <60 ml/min/1.73m2 accompanied by >25% decline eGFR or CKD hospitalization. Secondary analysis - eGFR slope. Primary analysis - Cox regression models to calculate hazard ratio (HR). Secondary analysis - multilevel mixed effects models to estimate the eGFR slope across visits. Median follow-up was 6.6 years. 460 participants developed incident CKD (incidence rate 22.0/1,000 person-years). The highest quartiles (Q4) of cfPWV, hfPWV, and haPWV were associated with an increased risk of incident CKD compared to the lowest quartile (Q1) (HRs, 1.53 [95% CI, 1.15 to 2.04] and 1.49 [95% CI, 1.12 to 1.99], and 1.56 [95% CI, 1.16 to 2.08], respectively). 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 (e.g., for cfPWV, -0.44 mL/min/1.73 m2/year [95% CI, -0.56 to -0.33] in Q4 versus -0.37 [95% CI, -0.48 to -0.26] in Q1). All p-value <0.05. faPWV was not associated with incident CKD or eGFR slope. Residual confounding. 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.