The Role of Central Aortic Pressure Monitoring in the Management of Patients with Chronic Kidney Disease
Using Central Aortic Pressure to Monitor Chronic Kidney Disease Patients
Central Aortic Pressure Monitoring in the Management of Patients with Chronic Kidney Disease
Chronic kidney disease (CKD) is common and effects approximately 15% of adults in the USA (37 million people). Kidney disease is the ninth leading cause of death. CKD increases the risk for cardiac disease, stroke, and death, and leads to multiple significant additional diseases. Hypertension and diabetes are the leading causes of CKD in adults and also represent the most treatable targets to prevent CKD and to reduce CKD progression.
Central aortic systolic pressure is highly correlated to brachial systolic pressures; however, central systolic pressures cannot be reliably inferred from brachial pressures. Elevated central aortic pressure is predictive of end-organ damage including impaired renal function. Brachial and central aortic pressures provide complimentary information for risk prediction and management decisions. The risk of cardiovascular events is associated with elevated central pressures and these risks have been shown in multiple studies to be superior, and in others, at least as high than that associated with brachial pressures. A recent meta-analysis, which incorporated multiple baseline factors including brachial systolic pressure, demonstrated that central systolic pressure is independently predictive of cardiovascular events and therefore provides additional risk information.
Prescription of anti-hypertension medications has the potential of significant benefit but as with all medications, may be associated with adverse consequences (hypotension and drug specific adverse effects) and should always be judicious and carefully considered, particularly in patients with CKD. Assessment of central pressures provides relevant information that informs prescription medication needs.
Measurements of central arterial pressures can be incorporated into the current approaches to hypertension management as the dual arterial pressure SphygmoCor XCEL device, the only FDA cleared medical device for non-invasive central arterial pressure waveform analysis for all adults, can provide both brachial and central aortic pressures in the same clinic setting.