Integrated central blood pressure-aortic stiffness risk score for cardiovascular risk stratification in chronic kidney disease.

ABSTRACT

BACKGROUND AND AIMS: The aim of this study was to develop an integrated central blood pressure-aortic stiffness (ICPS) risk score to predict cardiovascular events. METHODS: It was a retrospective cohort study. A total of 100 chronic kidney disease (CKD) patients on conservative therapy were included. Pulse wave velocity (PWV), central systolic blood pressure (cSBP), and central pulse pressure (cPP) were measured. A score was assigned to tertiles of PWV (0-2), cPP (0-2), and cSBP (0 to the first and second and 1 to the third tertile) based on each parameter's ability to individually predict cardiovascular outcome. The sum of these scores and three ICPS risk categories as predictors were studied. Finally, we compared discrimination of the ICPS risk categories with PWV, cSBP, and cPP. RESULTS: Adjusted for age and sex, patients in high and very high ICPS risk categories had increased cardiovascular risk (HR 3.52, 95% CI 1.65-7.49; HR 7.56, 95% CI 3.20-17.85, respectively). High and very high ICPS risk categories remained independent predictors in a model adjusted for multiple CV risk factors (HR 4.58, 95% CI 1.65-7.49; HR 8.56, 95% CI 3.09-23.76, respectively). ICPS risk categories (Harrell's C 0.723, 95% CI 0.652-0.795) showed better discrimination than PWV (Harrell's C 0.659, 95% CI 0.586-0.732, p = 0.028) and cSBP (Harrell's C 0.660, 95% CI 0.584-0.735, p = 0.008) and there has been a tendency of significance in case of cPP (Harrell's C 0.691, 95% CI 0.621-0.761, p = 0.170). CONCLUSION: The ICPS score may clinically importantly improve the identification of CKD patients with elevated cardiovascular risk.