To the Editor,

We read the article “Progression of Aortic Pulse Wave Velocity in Patients With Chronic Kidney Disease” by Susanne Tholen and coworkers with great interest.[1] They investigated arterial stiffness in a cohort of 70 patients with chronic kidney disease (CKD) after 1 year to the natural progression of arterial stiffness and defined clinical parameters potentially associated with accelerated progression of arterial stiffness. They concluded that arterial stiffness in CKD patients is characterized by a significant increase in arterial stiffness during the course of 1 year. The progression reaches a level that is known to significantly increase cardiovascular risk. We believe that these findings will be guides for further studies about the effect of inflammation on arterial stiffness parameters in patients with CKD.

Endothelial dysfunction (ED) is an early stage in the pathogenesis of cardiovascular disease. Arterial stiffness has high cardiovascular predictive value, reproducibility, cost-effectiveness, and availability in many healthcare facilities and is suggested within additional tests in the evaluation of ED.[2] These parameters are important both for research and clinical use. In clinical practice, noninvasive devices in particular are becoming increasingly common to measure arterial stiffness. It occurs as a result of known atherosclerotic risk factors such as hypertension, smoking, hypercholesterolemia, diabetes mellitus, and aging. Increased arterial stiffness is a common finding of atherosclerotic involvement of the vascular system.[3] However, increased arterial stiffness is an indicator of coronary artery disease, cerebrovascular disease, and peripheral arterial disease.[4] However, the authors did not mention some other factors that affect arterial stiffness parameters.

Some of the factors that affect this marker include receiving lipid-lowering therapy, use of vitamins or antioxidants, inflammatory diseases such as Behçet disease,[5] psoriasis,[2] abnormality on thyroid function tests, malignancy, and any medication, eg, antihypertensive drugs, that can potentially interfere with measurements of arterial stiffness. So, we believe it would have been helpful for the authors to have provided information about these factors.

In the current study, the glomerular filtration rate (GFR) in patients with elevated serum creatinine levels was determined by the simplified Modification of Diet in Renal Disease (MDRD) formula. At present, the Cockcroft-Gault equation (CGE) is another method for calculating GFR. However, the CGE may measure lower GFR in younger age groups compared with the MDRD formula, but it can estimate higher GFR in older individuals compared with the MDRD formula.[6] The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) has recently published an equation for GFR using the same variables including serum creatinine level, age, sex, and race as the MDRD formula. However, the CKD-EPI equation more definitely categorized individuals with respect to estimating renal dysfunction compared with the MDRD formula.[7]

The fact that arterial stiffness is a noninvasive method to assess ED in clinical practice and without other inflammatory markers, arterial stiffness alone may not provide information to clinicians about the prognosis in patients with CKD.


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  • 1
    Tholen S, Klofat K, Pan CR, et al. Progression of aortic pulse wave velocity in patients with chronic kidney disease. J Clin Hypertens (Greenwich). 2013;15:833838.
  • 2
    Balta I, Balta S, Demirkol S, et al. Aortic arterial stiffness is a moderate predictor of cardiovascular disease in patients with psoriasis vulgaris. Angiology. 2014;65:74-78.
  • 3
    Balta S, Cakar M, Demirkol S, et al. Arterial stiffness itself without other inflammatory markers may not provide information to clinicians. J Clin Hypertens (Greenwich). 2013;15:303.
  • 4
    Willum-Hansen T, Staessen JA, Torp-Pedersen C, et al. Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation. 2006;113:664670.
  • 5
    Balta I, Balta S, Koryurek OM, et al. Mean platelet volume is associated with aortic arterial stiffness in patients with Behçet's disease without significant cardiovascular involvement. J Eur Acad Dermatol Venereol. 2013; doi: 10.1111/jdv.12297; In press.
  • 6
    Balta S, Demırkol S, Karaman M. Renal dysfunction may predict new onset heart failure. Am Heart J. 2013;166:e5.
  • 7
    Matsushita K, Selvin E, Bash LD, et al. Risk implications of the new CKD epidemiology collaboration (CKD-EPI) equation compared with the MDRD study equation for estimated GFR: the atherosclerosis risk in communities (ARIC) study. Am J Kidney Dis. 2010;55:648659.