Vol.:(0123456789) 1 3 International Urology and Nephrology https://doi.org/10.1007/s11255-019-02336-6 NEPHROLOGY - ORIGINAL PAPER Cardio‑ankle vascular index is linked to deranged metabolic status, especially high HbA1c and monocyte‑chemoattractant‑1 protein, in predialysis chronic kidney disease Mehmet Mert 1  · Belda Dursun 2  · Ahmet Baki Yağcı 3  · Ayşen Çetin Kardeşler 4  · Hande Şenol 5  · Süleyman Demir 4 Received: 2 June 2019 / Accepted: 6 November 2019 © Springer Nature B.V. 2019 Abstract Introduction and purpose Arterial stifness is an independent predictor of cardiovascular disease in chronic kidney disease (CKD). Cardio-ankle vascular index (CAVI) is a newly developed method used to assess arterial stifness, independent of changes in blood pressure. CAVI refects stifness and atherosclerosis at the thoracic, abdominal, common iliac, femoral, and tibial artery levels. In predialysis stage 3–5 diabetic and nondiabetic CKD patients, CAVI levels and its relation to atherosclerosis-associated risk factors including monocyte-chemoattractant protein-1 (MCP-1), sclerostin, fbroblast growth factor-23 (FGF-23), Klotho, and 25-OH vitamin D were determined. Materials and methods The study was performed on three age-matched and gender-matched groups. Group 1 included 46 stage 3–5 nondiabetic CKD patients, group 2 included 44 stage 3–5 diabetic CKD patients, and group 3 included 44 non- uremic controls. All subjects underwent CAVI measurement. Serum glycated hemoglobin (HbA1c), total calcium, phos- phorus, parathormone, FGF-23, Klotho, MCP-1, sclerostin, and 25-OH vitamin D were determined using standard methods. Results CAVI level was 8.22 ± 0.18 m/s in diabetic CKD patients and signifcantly higher than in nondiabetic CKD (7.61 ± 0.18 m/s) and control (7.59 ± 0.17 m/s) patients. FGF-23 level was higher in the CKD groups than controls but not statistically signifcant. MCP-1 level was signifcantly higher in diabetic CKD patients. Klotho and sclerostin levels were signifcantly lower in diabetic CKD patients. In the whole cohort, CAVI showed positive correlations with age (r = 0.447, p < 0.0001), smoking (r = 0.331, p = 0.035), mean arterial blood pressure (MABP; r = 0.327, p < 0.0001), fasting blood glu- cose (r = 0.185, p = 0.033), and HbA1c (r = 0.258, p = 0.003). Stepwise regression analysis revealed that age (p = 0.0001, B = 0.461), MABP (p < 0.0001, B = 0.365), HbA1c (p = 0.003, B = 0.251), and MCP-1 (p = 0.013, B = 0.214) independently predicted CAVI levels. Conclusion Our results indicate higher CAVI levels, therefore, resulting in increased arterial stifness in the setting of dia- betic CKD. Apart from age and MABP, deranged metabolic status, especially increased HbA1c and MCP-1 levels, is also independently associated with increasing CAVI levels in CKD patients. These results emphasize the importance of metabolic control in the development of arterial stifness in CKD patients, which is an early predictor of developing cardiovascular complications. Keywords Atherosclerosis · CAVI · CKD · DM · Infammation · MCP-1 Mehmet Mert and Belda Dursun are contributed equally to this work. * Mehmet Mert mehmetmert88@hotmail.com 1 Internal Medicine, Tavas State Hospital, Denizli, Turkey 2 Nephrology, Pamukkale University Medical School, Denizli, Turkey 3 Radiology, Pamukkale University Medical School, Denizli, Turkey 4 Biochemistry, Pamukkale University Medical School, Denizli, Turkey 5 Biostatistics, Pamukkale University Medical School, Denizli, Turkey