Clinical Implications of Pulse Pressure in Chronic Kidney Disease

Han, Seung Hyeok; Lee, Sang Cheol; Lee, Jung Eun; Ahn, Song Vogue; Kim, Bum Suk; Kang, Shin Wook; Lee, Ho Yung; Han, Dae Suk; Choi, Kyu Hun

Abstract

BACKGROUND: Arterial hypertension is one of the major factors for progression to end stage renal disease (ESRD) in chronic kidney disease (CKD). Pulse pressure, which stands for arterial stiffness, is a well known risk factor for cardiovascular disease, especially in old patients. A few reports showed that increased arterial stiffness is associated with decreased glomerular filtration rate (GFR). The aim of this study is to investigate the effects of pulse pressure on renal outcome in CKD patients.
METHODS
Total 153 patients were included who visited our institution for the first time between January 2000 and December 2000. Patients' medical records were reviewed retrospectively. CKD was defined as GFR by MDRD equation less than 60 mL/ min/1.73 m2. Patients with CKD 5 were excluded. The primary end point of this study for progression of renal disease was doubling serum creatinine.
RESULTS
On multivariate analysis based on baseline clinical and laboratory data, pulse pressure was an independent risk factor for progression of CKD. Antihypertensive treatment for 1 year (since the first visit) decreased both systolic and diastolic blood pressure (BP) significantly, and pulse pressure as well. At the end of follow up of 3.7 years (mean), while systolic BP tended to increase slightly, diastolic BP was persistently decreased. Consequently, pulse pressure was further widened compared to that of 1 year. Pulse pressure was positively correlated with age, fasting glucose, and calcium phosphorus product (CPP) whereas it was negatively correlated with hemoglobin and GFR.
CONCLUSION
This study shows that pulse pressure is a good predictor for renal outcome in CKD. Besides age and hypertension, anemia, fasting glucose, CPP and uremia can adversely affect pulse pressure in CKD. Therefore, BP control and correction of those factors are recommended to attenuate the progression of CKD.