{"doi":"10.2215/cjn.06420521","title":"Arterial Stiffness Is Independently Associated with Acute Kidney Injury in SPRINT","abstract":"AKI is defined by an abrupt decrease in kidney function and is associated with significant morbidity and mortality, including kidney disease progression and higher cardiovascular disease risk (1). Greater arterial stiffness is also associated with higher risk for kidney function decline and cardiovascular disease (2,3). The gold standard for measuring arterial stiffness is carotid-femoral pulse wave velocity (PWV). Whether greater carotid-femoral PWV predicts incident AKI is unknown. We examined the association of carotid-femoral PWV and incident AKI among individuals at high cardiovascular risk who participated in the Systolic Blood Pressure Intervention Trial (SPRINT). SPRINT was a randomized trial comparing intensive systolic BP treatment (<120 mm Hg) with standard treatment (<140 mm Hg) on cardiovascular outcomes in 9361 nondiabetic hypertensive participants (4). A subset of 613 individuals without atrial fibrillation recruited from 11 of the 102 clinical sites participated in a carotid-femoral PWV ancillary study and were included in this analysis (5). Participants recruited to the ancillary study were slightly older and more likely to be White; they had lower prevalence of cardiovascular disease but higher prevalence of CKD compared with SPRINT participants not included. Detailed methods are described elsewhere (4,5). In SPRINT, AKI was on the basis of the modified Kidney Disease Improving Global Outcomes criteria incorporating only serum creatinine concentration and included if the AKI event was recorded as an adjudicated serious adverse event (SAE). We used multivariable-adjusted Cox proportional hazards models to examine the association between baseline carotid-femoral PWV and incident AKI. Carotid-femoral PWV was examined as a categorical variable, and participants with carotid-femoral PWV greater than or equal to median (10.4 m/s) were compared with those with carotid-femoral PWV less than median. Carotid-femoral PWV was also examined as a continuous variable: risk of AKI per 1-m/s higher. All statistical analyses were performed with SAS software version 9.4 (SAS Institute, Cary, NC). P values of 0.05 were considered statistically significant. Baseline characteristics were similar between the two groups (carotid-femoral PWV greater than or equal to median and less than median). The mean ± SD age was 72±9 years, 40% were women, 69% were White, and mean eGFR was 67±20 ml/min per 1.73 m2. Those with baseline carotid-femoral PWV greater than or equal to median were older and had higher systolic BP than those with carotid-femoral PWV less than median. Over a median of 453 (interquartile range, 289–724) days, there was a total of 20 adjudicated SAE AKI events (18 in the group with carotid-femoral PWV greater than or equal to median and two in the group with carotid-femoral PWV less than median). Carotid-femoral PWV was strongly associated with AKI among individuals at high risk of cardiovascular disease who participated in SPRINT (Table 1). This strong association remained when carotid-femoral PWV was analyzed as a continuous variable after adjusting for demographics, including age, and clinical risk factors, including systolic BP, preexisting cardiovascular disease, CKD, and heart rate (Table 1). Table 1. - Association of arterial stiffness as measured by carotid-femoral pulse wave velocity with AKI Models Hazard Ratio (95% Confidence Interval) Per 1-m/s Higher Carotid-Femoral Pulse Wave Velocity Carotid-Femoral Pulse Wave Velocity ≥ Median a versus Carotid-Femoral Pulse Wave Velocity < Median a Unadjusted 1.22 (1.07 to 1.39) 9.28 (2.15 to 40.00) Model 1: Age, sex, race, randomization assignment 1.26 (1.10 to 1.45) 10.67 (2.45 to 46.55) Model 2: Model 1 + smoking category, history of cardiovascular disease, no. of antihypertensives 1.27 (1.10 to 1.45) 11.33 (2.59 to 49.66) Model 3: Model 2 + eGFR, UACR, systolic BP, HR 1.32 (1.13 to 1.54) 13.28 (2.91 to 60.58) UACR, urine albumin-creatinine ratio; HR, heart rate.aCarotid","journal":"Clinical Journal of the American Society of Nephrology","year":2021,"id":196965,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":4,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9621,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":770215,"name":"Nina Z. Bispham","orcid":"0000-0003-1485-4018","position":1,"is_corresponding":false},{"id":372950,"name":"Zhiying You","orcid":null,"position":2,"is_corresponding":false},{"id":477707,"name":"Ester Oh","orcid":"0000-0003-4942-0762","position":3,"is_corresponding":false},{"id":295958,"name":"Mark A. Supiano","orcid":"0000-0002-5438-5087","position":4,"is_corresponding":false},{"id":335791,"name":"Michel B. Chonchol","orcid":null,"position":5,"is_corresponding":false},{"id":409878,"name":"Kristen L. Nowak","orcid":"0000-0001-9364-3256","position":6,"is_corresponding":false},{"id":365277,"name":"Anna Jovanovich","orcid":null,"position":7,"is_corresponding":false},{"id":770869,"name":"Michelle H. Pengshung","orcid":null,"position":0,"is_corresponding":true}],"reference_count":5,"raw_metadata":null,"created_at":"2026-07-18T23:50:19.568641Z","pmid":"34452880","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}