Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
e132 Abstracts
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved
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POSTER SESSION
POSTERS’ SESSION P07:
KIDNEY AND RAAS
RELATIONSHIP BETWEEN ARTERIAL STIFFNESS AND CHRONIC
KIDNEY DISEASE IN PATIENTS WITH HYPERTENSION
J. Zuo
1
, Y. Hu
2
, G. Chang
1
, S. L. Chu
1
, M. Butlin
3
, I. Tan
3
, A. Avolio
3
.
1
Department of Hypertension, Ruijin Hospital North, Shanghai Jiaotong Univer-
sity School of Medicine, Shanghai, China,
2
Department of Geriatrics Ruijin Hos-
pital North, Shanghai Jiaotong University School of Medicine, Shanghai, China,
3
Department of Biomedical Sciences, Faculty of Medicine and Health Sciences,
Macquarie University, Sydney, AUSTRALIA
Objective: Previous studies have shown an association between arterial stiffness
and kidney disease. Arterial stiffness, as measured by carotid-femoral pulse wave
velocity (cfPWV) has been shown to be a strong prognostic marker in end-stage
renal disease. This study aimed to investigate the association of noninvasive indices
of arterial stiffness with chronic kidney disease (CKD) in patients with hypertension.
Design and method: Hypertensive hospital inpatients (n = 574, mean age 60 ± 10
years, 344 males) were recruited for this study, comprising 337 hypertensive patients
without CKD and 210 hypertensive patients with CKD. We measured noninvasive
arterial stiffness indices including central arterial haemodynamics using pulse wave
analysis (SphygmoCor, AtCor Medical, Sydney), cfPWV (Complior SPIV, France),
large and small artery elasticity indices (C1, C2 respectively) (CVProfilor, HDI,
USA), and intima-media thickness (IMT) evaluated by ultrasonography (HD11EX,
Philips Medical Systems). The diagnosis of CKD was assessed by the estimated glo-
merular filtration rate (eGFR) or urinary albumin creatinine ratio (ACR).
Results: Compared to hypertensive patients without CKD, hypertensive patients
with CKD were older, had higher central aortic blood pressure, cfPWV and IMT (all,
p < 0.01). With decreasing eGFR, cfPWV and augmentation index adjusted to heart
rate of 75 bpm increased progressively whereas C2 decreased (p < 0.05) in subjects
with CKD. C1 and C2 were negatively associated with log (ACR). In the overall
population, after adjusting for age, gender and brachial systolic blood pressure, only
cfPWV was negatively associated with eGFR (r = –0.092, p = 0.04). Multiple logistic
analysis showed that 1 SD (3 m/s) increase in cfPWV entailed a 1.35 times higher
risk of CKD organ damage after adjustment for various confounding factors.
Conclusions: Of all the noninvasive indices of arterial stiffness measured in this
study, cfPWV has been found to have an independent association with CKD in
patients with hypertension. cfPWV may be a potential index to evaluate the risk
of CKD in primary hypertension.
A PROSPECTIVE STUDY OF THE EFFECT OF CHRONIC KIDNEY
DISEASE ON THE INCIDENCE OF CARDIOVASCULAR EVENTS IN A
NATIVE SPANISH POPULATION
N. R. Robles Perez-Monteoliva
1
, B. Cancho
1
, F. Felix
2
, L. Lozano
3
,
D. Fernandez-Berges
4
.
1
Hospital Universitario De Badajoz, Badajoz, SPAIN,
2
C.
S. Villanueva de La Serena Norte, Villanueva de La Serena, SPAIN,
3
C. S. Merida,
Merida, SPAIN,
4
Unidad de Investigacion, Fundesalud, Villanueva de La Serena,
SPAIN
Objective: To evaluate the relationship between chronic kidney disease (CKD)
defined through estimated glomerular filtration rate (GFR) and the patient’s car-
diovascular risk measured through the incidence of major adverse cardiovascular
events in a sample of Spanish population.
Design and method: The sample consisted of 2,668 subjects. Mean age was
50.6 ± 14.5 years and 54.6% were female. GFR was estimated from serum cre-
atinine using the CKD-EPI equation. Urinary albumin excretion (UAE) was
measured in first morning urine sample as mg/g of creatinine. We examined the
multivariable association between the estimated GFR and the risks of cardiovas-
cular events and death. The median follow-up was 132 months.
Results: In all, 3.5% (n = 93) of subjects had a GFR below 60 ml/min and 4.3% (n
= 115) an UAE above 30 mg/g. The hazard ratio for cardiovascular events was 2.74
(95%CI 1.37–5.45) (p < 0.001) for CKD patients and the hazard ratio (HR) for CV
mortality was 1.62 (95%CI 0.53–4.91) (p = 0.396). Moreover, increases UAE was also
associated to higher cardiovascular risk (HR 2.38, 95%CI 1.55–3.66, p < 0.001) as
well as increased CV mortality (HR 3.72, 95%CI 2.07–6.62, p < 0.001). For patients
with UAE between 30 and 300 mg/g HR for cardiovascular events was 3.24 (95%CI,
1.61–6.49, p < 0.001) and 6.28 (95%CI 2.37–16.6, p < 0.001) for CV mortality.
Conclusions: An independent association was observed between a reduced estimat-
ed GFR and the risk of cardiovascular events in a community based population. High
UAE was independently associated with high cardiovascular morbidity and mortality.
These findings highlight the clinical and public health importance of chronic renal
insufficiency.
ADJUSTING EQUATIONS FOR GLOMERULAR FILTRATION RATE
FOR BODY SURFACE AREA USING DUBOIS AND MOSTELLER
FORMULAS
M. Matasin
1
, V. Domislovic
2
, K. Dapic
1
, M. Fucek
1,3
, V. Ivkovic
1,4
,
S. Karanovic
1,4
, I. V. Brinar
1,4
, A. Jelakovic
1,4
, L. Simicevic
3
, J. Josipovic
5
,
Z. Dika
1,4
, B. Milicic
1
, B. Jelakovic
1,4
.
1
School of Medicine, University of Zagreb,
Zagreb, CROATIA,
2
Department of Gastroenterology and Hepatology, University
Hospital Center Zagreb, Zagreb, CROATIA,
3
Department of Clinical Laboratory
Diagnostics, University Hospital Center Zagreb, Zagreb, CROATIA,
4
Department
of Nephrology, Art. Hypertension, Dialysis and Transplantation, University Hos-
pital Center Zagreb, Zagreb, CROATIA,
5
Department of Nephrology and Dialysis,
University Hospital Center Sestre milosrdnice, Zagreb, CROATIA
Objective: According to recent guidelines glomerular filtration rate (GFR)
should be estimated using CKD-Epi equation where GFR is indexed to unique
body surface (BSA) value of 1.73m2. This approach was questioned and not only
discussion how GFR should be indexed but also how BSA should be predicted.
Our aim was to analyze differences between eGFR (classic CKD-Epi) and those
where BSA was predicted with DuBois and Mosteller equations (eGFR-DB,
eGFR-M). Furthermore, we adjusted GFR for individual BSA values.
Design and method: Random sample of 2058 subjects from rural population
(ENAH study); average age 50.1, 60.16% f. Du Bois and Mosteller equations for
BSA were used and were incorporated into CKD-EPI equation (CKD-DB, GFR-
M) after which subjects were classified into CKD stages.
Results: Significant difference in BSA values calculated with DuBois and Mo-
steller equations were found (1.87 ± 0.21 m2vs.1.90 ± 0.22 m2; p < 0.0001),
both being significantly higher than currently recommended value of 1.73 m2. We
found significant differences between eGFR using CKD-Epi, CKD-DB and CKD-
M (85.89 ml/min/1.73m2 vs. 92.84 ml/min/1.87m2 vs. 94.33 ml/min/1.90m2, re-
spectively; p < 0.0001). Importantly, significant difference was observed in clas-
sification in CKD stages when calculating individual BSA using two formulas
(Table 1) – a higher proportion of subjects in stage G1 and less in G2 were found
when using DuBois Moesteller (P < 0.0001).
Conclusions: Compared to eGFR-DB and eGFR-M equations CKD Epi equa-
tion underestimates GFR. This finding suggest that eGFR should be estimated
using either DuBois or Moesteller equations, or ideally to correct eGFR for
individual BSA. At population level this is important for proper determination
of CKD prevalence and better classification of CKD stages, while at individual
level this could be valuable on clinical decisions or correcting drug dosages.
PROGNOSTIC VALUE OF KIDNEY ACUTE INJURY EPISODES IN
HEART FAILURE
J. Holgado, C. Lopez, A. Fernandez, I. Sauri, A. Ruiz, F. Martinez, J. Redon. Car-
diovascular and Renal Risk Group, INCLIVA Research Institute and Hypertension
Clinic, Hospital Clinic, Valencia, SPAIN