Pulse wave velocity is a marker for arterial stiffness, and indicative of increased cardiovascular morbidity and mortality in the general population. Upstroke time (UT) of arterial pulse, defined as time from the initial rise to the peak of the wave, is another parameter for arterial stiffness that is obtained during brachial-ankle pulse wave velocity (baPWV) measurement. Studies have shown significant association between baPWV and cardiovascular events or mortality in hemodialysis patients. However, there are few studies examining such relationship in non-hemodialysis chronic kidney disease (CKD) patients. Moreover, clinical utility of UT among these patients remains unknown. The present study aimed to examine the association between UT and the presence of coronary heart disease (CAD) in non-hemodialysis CKD patients.Design and Method:
We enrolled 105 patients (35 non-hemodialytic CKD; 70 non-CKD) who measured baPWV and UT and underwent elective coronary angiography for suspected CAD. CKD was defined as estimated glomerular filtration rate below 60 ml/min/1.73m2. Significant coronary artery disease (sCAD) was defined as one or more stenosis over 50%. To examine the contribution of baPWV and UT for the presence of sCAD, multivariate logistic regression analysis with adjustment for potential confounders was performed in each patient group.Results:
In non-hemodialysis CKD patients, UT but not baPWV was associated with sCAD (UT: Odds Ratio(OR) 1.62[95% Confidence Interval (95% CI) 1.05–2.50], p = 0.029; baPWV: OR 1.13[95% CI 0.90–1.42], p = 0.280) in univariate logistic regression analysis. In multivariate analysis, UT remained significant after adjusting traditional risk factors and other potential confounders (OR 12.4 [95% CI 1.02–151.3]; p = 0.036). In non-CKD patients, neither UT nor baPWV was associated with sCAD in both univariate and multivariate analysis.Conclusions:
In non-hemodialysis CKD patients, UT serves as independent predictive risk for the presence of significant CAD.