Supplementary Material for: Aortic calcification and pulse wave velocity remain associated after adjustment for kidney function and covariates

Background: Aortic wall calcification increases arterial stiffness which is often assessed by carotid-femoral pulse wave velocity (cfPWV). However, the impact of kidney function upon the association between calcification of the aortic wall and cfPWV remains unknown. Methods: To examine the association between aortic calcification and cfPWV, we prospectively recruited CKD patients (estimated glomerular filtration rate (eGFR)<60 ml/min/1.73 m2) and patients with normal renal function, planned for invasive coronary angiography. Participants underwent a non-contrast computed tomography scan of the entire aorta with subsequent Agatston scoring of the aortic wall in addition to a standardized cfPWV measurement and biochemical markers. Results: A total of 144 patients (67.1±10.3 years, 24% female), of whom 110 had CKD (26 stage 3a, 33 stage 3b, 24 stage 4 and 27 stage 5), were included. Agatston score was associated with cfPWV in a univariate regression analysis (p<0.001). So was age (p<0.001) and diabetes (p=0.001), but not gender, smoking status, eGFR, office systolic blood pressure, calcium-phosphate product, C-reactive protein nor vasodilator treatment. Multiple regression analysis including all these factors did not significantly change these associations and relative weight analysis revealed Agatston score to account for 30% of the variation in cfPWV in the model (total r2 =0.31). Conclusion: In a cohort representing the entire spectrum of kidney function, aortic Agatston score, as well as age and diabetes, were associated with cfPWV after adjustment for other risk factors including eGFR. However, most of the variation in cfPWV remains unexplained by these factors.

背景：主动脉壁钙化可加重动脉僵硬度，而动脉僵硬度通常通过颈股动脉脉搏波速度（carotid-femoral pulse wave velocity, cfPWV）进行评估。然而，肾功能对主动脉壁钙化与cfPWV之间关联的影响仍尚不明确。方法：为探究主动脉钙化与cfPWV之间的关联，本研究前瞻性招募了估算肾小球滤过率（estimated glomerular filtration rate, eGFR）<60 ml/min/1.73 m²的慢性肾脏病（Chronic Kidney Disease, CKD）患者，以及计划接受有创冠状动脉造影术的肾功能正常者。所有受试者均接受全主动脉非增强计算机断层扫描，以完成后续主动脉壁阿加斯顿钙化评分，同时接受标准化cfPWV测量与生化标志物检测。结果：本研究共纳入144例患者（年龄67.1±10.3岁，女性占24%），其中110例为CKD患者（26例3a期、33例3b期、24例4期、27例5期）。单变量回归分析显示，阿加斯顿评分与cfPWV显著相关（p<0.001）；年龄（p<0.001）与糖尿病（p=0.001）亦存在此关联，但性别、吸烟状态、eGFR、诊室收缩压、钙磷乘积、C反应蛋白及血管扩张剂治疗均无此关联。纳入所有上述因素的多变量回归分析并未显著改变上述关联，相对权重分析显示，在模型中阿加斯顿评分可解释cfPWV变异的30%（总决定系数r²=0.31）。结论：在覆盖全肾功能谱系的队列中，在校正包括eGFR在内的其他危险因素后，主动脉阿加斯顿评分与年龄、糖尿病均与cfPWV显著相关。然而，上述因素仍无法解释cfPWV的大部分变异。