Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Paper Kidney Blood Press Res 2007;30:283–288 DOI: 10.1159/000105264 Pulse Pressure Is an Independent Predictor of Aortic Stiffness in Patients with Mild to Moderate Chronic Kidney Disease Benedetta Stancanelli a Lorenzo S. Malatino a Graziella Malaponte b Paola Noto a Eliana Giuffrè a Alessia Caruso a Carmela Gagliano a Anna Maria Zoccolo a Giuseppe Puccia a Pietro Castellino a Departments of a Medicine and Systemic Diseases, and b Biomedical Sciences, University of Catania, Catania, Italy study confirm an aPWV increase in mild to moderate CKD and emphasize association between pulse pressure and PWV, independently of renal failure. Copyright © 2007 S. Karger AG, Basel Introduction It is well recognized that the age-adjusted mortality rate in patients with end-stage renal disease (ESRD) is much higher than in the general population and that car- diovascular disease is the leading cause of death. Thus, approximately 40% of ESRD patients on maintenance di- alysis show clinical evidence of coronary artery disease and carry, particularly younger patients, a number of car- diovascular risk factors leading to death for cardiovascu- lar disease [1, 2]. Vascular calcifications are on the other hand known to substantially contribute to high cardio- vascular mortality in ESRD [1–6], likely causing the de- velopment of premature and accelerated atherosclerosis [7–9] . It is well known that arterial intimal calcifications develop in an advanced stage of atherosclerosis, while medial calcifications usually occur with aging and diabe- tes mellitus, besides ESRD. Both types of arterial calcifi- cation cause a loss in arterial compliance, thus leading to a progressive stiffening of the arterial tree that is associ- Key Words Pulse wave velocity  Augmentation index  Chronic kidney disease  Atherosclerosis  Arterial stiffness Abstract Background: In patients with end-stage renal disease pulse wave velocity (PWV) has been widely assessed, but its be- havior in mild to moderate chronic kidney disease (CKD) has been less investigated. We evaluated PWV in mild to moder- ate CKD. Methods: We studied 31 patients with grade II–IV CKD. Aortic PWV (aPWV), aortic and upper limb augmenta- tion index, creatinine clearance, C-reactive protein, serum fibrinogen, interleukin-1, interleukin-6, tumor necrosis fac- tor, albumin, total and high-density lipoprotein cholesterol and blood pressure were evaluated. Results: aPWV (7.95 8 0.64 m/s), but not augmentation index was significantly higher (p = 0.03) in CKD patients than age-matched healthy subjects (aPWV: 6.24 8 0.43 m/s; upper limb: 32.8 8 1.9; aortic: 27.7 8 1.9). At univariate regression analysis, aPWV was significantly correlated with age (r = 0.44; p = 0.013), in- terleukin-6 (r = 0.43; p = 0.027), pulse (r = 0.39; p = 0.029), systolic blood pressure (r = 0.37; p = 0.038) and tumor necro- sis factor (r = 0.39; p = 0.029). At multivariate analysis, pulse pressure was the only significant independent determinant ( = 0.37; p = 0.05) of aPWV. Conclusion: The results of this Received: March 2, 2007 Accepted: May 18, 2007 Published online: July 6, 2007 Prof. Lorenzo S. Malatino Department of Medicine and Systemic Diseases Chair and Unit of Internal Medicine and Hypertension Center, University of Catania c/o Ospedale Civile, IT–97100 Ragusa (Italy) Tel. +39 0932 600 344, Fax +39 0932 600 217, E-Mail malatino@unict.it © 2007 S. Karger AG, Basel 1420–4096/07/0305–0283$23.50/0 Accessible online at: www.karger.com/kbr