Supplementary Material for: Association of arterial stiffness with chronic kidney disease: a systematic review

Introduction: Significant kidney function may be lost before CKD is diagnosed. Arterial stiffness may be a risk factor for CKD and the relationship may be bi-directional. We undertook a systematic review of cohort studies to ascertain the temporal relationship of arterial stiffness and CKD.
Methods: We searched MEDLINE and Embase to 4 October 2023 to identify studies that investigated whether arterial stiffness, as measured by pulse wave velocity, was predictive of the development or progression of CKD, rapid decline in kidney function and vice versa. The characteristics and outcomes of the included studies were set out in a qualitative summary. The review protocol is registered with PROSPERO (CRD42019129563).
Results: Forty-two studies were included, all of which were high quality with respect to bias. Thirteen of seventeen studies that investigated arterial stiffness as a predictor of incident CKD found a positive association (p<0.05) but when we only considered the 10 studies that controlled for CKD risk factors, 6 found a positive association. Eight of seventeen studies that investigated arterial stiffness as a predictor of progression of CKD, and five out of eight studies which investigated rapid kidney decline, found a positive association. One study of six found kidney function was able to predict future elevated arterial stiffness.
Conclusion: Arterial stiffness may predict incident CKD and a rapid decline in CKD. We are uncertain if arterial stiffness is associated with CKD progression or whether reduced kidney function is predictive of increased arterial stiffness. Further longitudinal research is required.

引言：慢性肾脏病（Chronic Kidney Disease, CKD）确诊前，患者可能已出现显著的肾功能丢失。动脉僵硬度（arterial stiffness）可能是CKD的危险因素，且二者的关联可能呈双向性。本研究针对队列研究（cohort study）开展系统评价（systematic review），以明确动脉僵硬度与CKD的时间关联。
方法：截至2023年10月4日，我们检索了MEDLINE与Embase数据库，筛选旨在探讨以脉搏波传导速度（pulse wave velocity, PWV）测量的动脉僵硬度是否可预测CKD发生、进展及肾功能快速下降的研究，反之亦然。我们对纳入研究的特征与结局进行了定性汇总。本研究的系统评价方案已在PROSPERO平台注册（注册号：CRD42019129563）。
结果：共纳入42项研究，所有研究在偏倚控制方面均为高质量。在17项探讨动脉僵硬度作为新发CKD预测因素的研究中，13项报告了阳性关联（P<0.05）；但仅纳入校正CKD危险因素的10项研究时，其中6项报告了阳性关联。在17项探讨动脉僵硬度作为CKD进展预测因素的研究中，8项报告了阳性关联；在8项探讨肾功能快速下降的研究中，5项报告了阳性关联。在6项探讨肾功能预测未来动脉僵硬度升高的研究中，1项发现肾功能可预测未来动脉僵硬度升高。
结论：动脉僵硬度或可预测新发CKD及CKD患者的肾功能快速下降。目前尚不确定动脉僵硬度是否与CKD进展相关，亦无法明确肾功能减退是否可预测动脉僵硬度升高，仍需开展进一步的纵向研究。