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Estimated Glomerular Filtration Rate and Urinary Albumin Excretion Are Independently Associated with Greater Arterial Stiffness: The Hoorn Study

Marc M.H. Hermans^*,, Ronald Henry^*, Jacqueline M. Dekker, Jeroen P. Kooman^*,, Piet J. Kostense, Giel Nijpels, Robert J. Heine and Coen D.A. Stehouwer^,

^* Department of Internal Medicine; Division of Nephrology, Academic Hospital Maastricht, Maastricht; Institute for Research in Extramural Medicine, Vrÿe Universiteit University Medical Center; and Department of Clinical Epidemiology and Biostatistics, Vrÿre Universiteit, Amsterdam, Netherlands

Address correspondence to: Dr. Marc M.H. Hermans, Department of Internal Medicine, Division of Nephrology, Academic Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, Netherlands. Phone: +31-43-3875007; Fax: +31-43-3876281; mherm{at}sint.azm.nl

Received for publication November 8, 2006. Accepted for publication March 15, 2007.

Mild renal insufficiency is a risk factor for cardiovascular disease (CVD). Both a decline in GFR and (micro)albuminuria are associated with greater cardiovascular mortality. In ESRD, arterial stiffness, an important cause of CVD, is known to be greater, but few data exist in individuals with mild renal insufficiency or microalbuminuria. This study investigated the association of impaired renal function expressed as lower GFR or greater urinary albumin excretion with arterial stiffness. In a population-based study in 806 individuals (402 men), mean age 68 yr (range 50 to 87), peripheral arterial stiffness (by compliance and distensibility of the carotid, brachial, and femoral arteries and by the carotid elastic modulus [E_inc]) and central arterial stiffness (by total systemic arterial compliance, carotid-femoral transit time, and aortic augmentation index) were measured ultrasonically. GFR was estimated (eGFR) by the Modification of Diet in Renal Disease (MDRD) formula. Urinary albumin excretion was expressed as urinary albumin/creatinine ratio (UACR). eGFR was 60.6 ± 11.1 ml/min per 1.73 m². Median UACR was 0.57 mg/mmol (range 0.1 to 26.6). After adjustment for age, mean arterial pressure (MAP), gender, and glucose tolerance status (GTS), each 5-ml/min per 1.73 m² lower eGFR was associated with a lower distensibility coefficient of the carotid (regression coefficient –0.20 10^–3/kPa; 95% confidence interval [CI] –0.34 to –0.07 10^–3/kPa) and brachial artery (–0.15 10^–3/kPa; 95% CI –0.28 to –0.03 10^–3/kPa) and a greater carotid E_inc (0.02 kPa; 95% CI 0.0004 to 0.04 kPa). No statistically significant association was found of eGFR with other arterial stiffness indices. After adjustment for age, MAP, gender, and GTS, a greater UACR (per quartile) was associated with a greater E_inc (0.03 kPa; 95% CI 0.001 to 0.07 kPa) and a trend to a lower distensibility coefficient (–0.24 10^–3/kPa; 95% CI –0.49 to 0.02 10^–3/kPa) of the carotid artery. After adjustment for age, MAP, gender, and GTS, a greater UACR (per quartile) was in addition associated with a shorter carotid-femoral transit time (–1.67 ms; 95% CI –3.24 to –0.10 ms). These associations were not substantially changed by mutual adjustment for eGFR and UACR. In individuals with mild renal insufficiency, both a lower eGFR and a greater albumin excretion, even below levels that are considered to reflect microalbuminuria, are independently associated with greater arterial stiffness. Moreover, these associations were mutually independent. These findings may explain, in part, why eGFR and microalbuminuria are associated with greater risk for CVD and suggest that amelioration of arterial stiffness could be a target of intervention.

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673