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American Journal of Epidemiology Advance Access originally published online on January 8, 2009
American Journal of Epidemiology 2009 169(6):740-748; doi:10.1093/aje/kwn392
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

The Differential Association of Kidney Dysfunction With Small and Large Arterial Elasticity

The Multiethnic Study of Atherosclerosis

Carmen A. Peralta, Ronit Katz, Magdalena Madero, Mark Sarnak, Holly Kramer, Michael H. Criqui and Michael G. Shlipak

Correspondence to Dr. Carmen A. Peralta, General Internal Medicine Section 111A1, Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94124 (e-mail: carmenalicia.peralta{at}ucsf.edu).

Received for publication September 16, 2008. Accepted for publication November 19, 2008.

Vascular remodeling may be a mechanism linking chronic kidney disease to cardiovascular disease. Whether early kidney dysfunction is associated with small and large arterial remodeling is not well understood. Using multivariable linear regression, back-transforming beta-coefficients to relative difference, the authors studied the association of cystatin C, creatinine-based estimated glomerular filtration rate (GFR), and albuminuria with small (SAE) and large (LAE) arterial elasticity and aortic distensibility among 6,282 participants in the Multiethnic Study of Atherosclerosis at baseline (2000–2002). Compared with the lowest quintile, higher quintiles of cystatin C were incrementally associated with lower SAE: third quintile relative difference = –5% (95% confidence interval (CI): –8, –2); fourth quintile relative difference = –10% (95% CI: –13, –8); and highest quintile relative difference = –16% (95% CI: –20, –12). By use of creatinine, the association was observed only among those with chronic kidney disease (estimated GFR, <60 mL/minute/1.73 m2): relative difference = –9% (95% CI: –13, –4). Albuminuria was significantly associated with lower SAE: relative difference = –6% (95% CI: –10, –1). Cystatin C was associated with lower LAE only at the highest quintile (relative difference = –3%, 95% CI: –6, 0) compared with the lowest quintile. By use of creatinine, chronic kidney disease was not independently associated with LAE (P = 0.912). Cystatin C, estimated GFR, and albuminuria were not associated with aortic distensibility (P = 0.26, 0.48, 0.45). Early kidney dysfunction is significantly associated with decreased arterial elasticity in smaller arteries and, to a lesser degree, in larger arteries.

albuminuria; cystatin C; elasticity; kidney; kidney diseases

Abbreviations: CI, confidence interval; GFR, glomerular filtration rate; LAE, large arterial elasticity; MESA, Multiethnic Study of Atherosclerosis; SAE, small arterial elasticity; SVR, system vascular resistance


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[Abstract] [Full Text] [PDF]


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