Creatinine clearance, pulse wave velocity, carotid compliance and essential hypertension

Background. The vascular hallmark of subjects with endstage renal disease i s increased arterial stiffness independent of blood pressure. wall stress, and cardiovascular risk factors such as hypertension, plasma glucose and ch olesterol, obesity, and tobacco consumption. Whether arterial stiffness and kidney function ale statistically associated in subjects with plasma creat inine less than or equal to 130 mu mol/L has not yet been determined. Material. In 1290 subjects with normal or elevated blood pressure values an d plasma creatinine less than or equal to 130 mu mol/L, subjects were divid ed into three tertiles according to the calculated creatinine clearance. Bl ood pressure aortic pulse wave velocity (PWV), and standard cardiovascular risk factors were determined in parallel. In 112 of the hypertensive subjec ts, common carotid and radial artery structure: and function (high-resoluti on echo-Doppler techniques) also were measured. Results. From the 1290 subjects, only the low-tertile group presented a sig nificant negative association between PWV and creatinine clearance independ ently of blood pressure and standard risk factors. This association was str onger in subjects less than or equal to 55 years of age. In the 112 hyperte nsive subjects, carotid compliance was positivsly correlated to creatinine clearance even after all adjustment for age, gender. and blood pressure. At less than 55 of the variance of carotid compliance. Such findings were not observed for radial artery compliance. Conclusion. Increased stiffness of central arteries is statistically associ ated with reduced creatinine clearance in subjects With mild-to-moderate re nal insufficiency, indicating that kidney alterations may interact not only with small but also large arteries, and this is independent of age, blood pressure. and standard risk factors.