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Cardio-ankle vascular index with renal progression and mortality in high atherosclerosis risk: a prospective cohort study in CORE-Thailand

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Abstract

Background

Increased arterial stiffness is linked to markers of endothelial dysfunction and vasculopathy such as albuminuria, vascular calcification, left ventricular hypertrophy and cardiovascular (CV) diseases. Studies of arterial stiffness on renal progression are limited.

Objective

The study aimed to evaluate the association between high cardio-ankle vascular index (CAVI) and renal endpoint and all-cause mortality in a Thai population with high atherosclerosis risk.

Methods

A multicenter prospective cohort study was conducted among subjects with high CV risk or established CV diseases in Thailand. Subjects were divided into 3 groups with mean CAVI < 8, 8–8.9, and ≥ 9, respectively. Primary composite outcome consisted of estimated glomerular filtration rate (eGFR) decline over 40%, eGFR less than 15 mL/min/1.73 m2, doubling of serum creatinine, initiation of dialysis and death related to renal causes. The secondary outcomes were all-cause mortality, CV mortality and eGFR decline.

Results

A total of 4898 subjects (2743 men and 2155 women) were enrolled. Cox proportional hazards model showed a significant relationship of high CAVI (CAVI ≥ 9) and primary composite outcome. Subjects with high CAVI at baseline had a 1.45-fold (95% CI 1.13–1.84) significant risk for the primary composite outcome and 1.72-fold (95% CI 1.12–2.63) risk for all-cause mortality, compared with normal CAVI (CAVI < 8). After stepwise multivariate analysis, the high CAVI group was only positively associated with primary composite outcome. Kaplan–Meier curve of the primary composite outcome and all-cause mortality demonstrated the worst survival in the high CAVI group (log-rank test with P < 0.05).

Conclusion

In a Thai cohort with high atherosclerosis risk, increased arterial stiffness was a risk factor for worsening renal function, including end-stage renal disease and initiation of dialysis.

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Acknowledgements

We wish to thank the Heart Association of Thailand under the Royal Patronage of HM the King and the National Research Council of Thailand for databases and data management support. We also acknowledge Ms Sujittra Suriwong for statistical analysis.

Funding

No funding.

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Authors and Affiliations

  1. Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand

    Noppawit Aiumtrakul, Ouppatham Supasyndh & Bancha Satirapoj

  2. Division of Cardiology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Rungroj Krittayaphong

  3. Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Arintaya Phrommintikul

Authors
  1. Noppawit Aiumtrakul
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  2. Ouppatham Supasyndh
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  3. Rungroj Krittayaphong
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  4. Arintaya Phrommintikul
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  5. Bancha Satirapoj
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Contributions

NA and BS reviewed the literature, provided valuable input in designing the study, drafted the article and revised it critically. OS, RK, and AP provided literature review and revised the manuscript critically. All authors read and approved the manuscript and met the criteria for authorship.

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Correspondence to Noppawit Aiumtrakul.

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The authors declare that no potential conflict of interest exists.

Statement of ethics

The study protocol was approved by the Joint Research Ethics Committee and Ministry of Public Health, Thailand. Informed consent was obtained from all patients.

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Aiumtrakul, N., Supasyndh, O., Krittayaphong, R. et al. Cardio-ankle vascular index with renal progression and mortality in high atherosclerosis risk: a prospective cohort study in CORE-Thailand. Clin Exp Nephrol 26, 247–256 (2022). https://doi.org/10.1007/s10157-021-02149-x

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  • DOI: https://doi.org/10.1007/s10157-021-02149-x

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