Associação entre marcadores de Disfunção Vascular e Doença Renal Crônica no ELSA-BRASIL

Abstract

Introduction: Chronic kidney disease (CKD) is a global public health problem with high prevalence, morbidity, mortality, and is also associated with an increased risk of cardiovascular events. CKD is associated with vascular dysfunction in several anatomical sites. The loss of elastic recoil, due to arterial stiffness and aortic calcification, results in hemodynamic changes which in turn can lead to damage to end organs such as kidneys. Objectives: First, verify the relationship between arterial stiffness, ascertained by carotidfemoral pulse wave velocity (cfPWV), and the incidence of chronic kidney disease (CKD) in individuals and verify if this association is present in individuals without hypertension and diabetes. Second, investigate the association between thoracic aorta calcification (TAC) and its segments and CKD in individuals without established cardiovascular disease, checking if arterial stiffness is a confounder of this relationship. Methods: The first article had a longitudinal design with 11,647 ELSA-Brasil participants followed for four years (2008/10- 2012/14). Baseline cfPWV was grouped by quartile, according to specific cut off points in relation to sex. The presence of CKD was verified by the glomerular filtration rate (GFR - CKDEPI < 60 ml/min/1.73 m² and/or albumin/creatinine ratio ≥ 30 mg/g. Logistic regression models were performed for the entire cohort and a subsample free of hypertension and diabetes at the beginning of the study. The second article was a cross-sectional study with 2,427 participants from ELSA-Brasil, participants in visit 2 of the study, in Belo Horizonte (2012-2015). TAC and its segments ascending (ATAC), aortic arch (AAC) and descending (DTAC) was categorized by the degree of calcification (0; upper than 0 and less than 100UH; and upper than 100UH). The presence of CKD was verified by GFR and CKDEPI < 60 ml /min/1.73m² and/or albumin/creatinine ratio ≥ 30 mg/g. Results: The chance of CKD was 42% (95% CI: 1.05;1.92) higher among individuals in the upper quartile of cfPWV. Among normotensive and non-diabetic participants, individuals in the 2nd, 3rd and 4th quartiles of cfPWV were more likely to develop CKD when compared to those in the lower quartile, with the magnitude of this association being greater for those in the higher quartile (OR: 1 .81 95% CI: 1.14;2.86). And when analyzing the association between aortic calcification and CKD, an association was found between DTAC and CKD in the group with the highest degree of calcification (OR: 2.66 - 1.05;6.71). The inclusion of PWV in the final model slightly increased the magnitude of the association with DTAC (OR: 2.75; 1.07-7.05). No statistical association was found for TAC, ATAC and AAC. Conclusion: Higher cfPWV increased the chances of CKD and suggests that this effect is even greater in individuals without diabetes and hypertension. The higher degree of DTAC is positively associated with CKD, regardless 8 of arterial stiffening. Our results reinforce the importance of knowing the role of subclinical vascular markers, as early factors in the development of CKD, in order to contribute to improving the prevention of the disease in population coverage.