Aortic to Brachial Pulse Pressure Amplification as Functional Marker and Predictor of Renal Function Loss in Chronic Kidney Disease

Pulse pressure amplification ( PPA ) reflects large artery function. Its contribution in chronic kidney disease ( CKD ) remains uncertain. The authors assessed PPA in CKD progression in patients with CKD stage 2 to 4 (n=128) and 89 controls (follow‐up: 42 months). PPA was reduced in CKD patients as compared with control patients and associated with decline in renal function. Sixteen renal endpoints, defined by 50% loss of renal function or start of renal replacement therapy, were detected. In Cox regression analysis, PPA , estimated glomerular filtration rate, and proteinuria predicted renal endpoints. Patients with CKD stage 4 and low PPA had the highest risk for developing renal endpoints (unadjusted 8.1; 2.4–27.7 and adjusted for age and proteinuria 5.6; 1.5–21.9, log‐rank P <.001). Taken together, PPA is reduced in CKD and is associated with declining renal function. In addition, low PPA predicts renal endpoints in severe CKD . Furthermore, this study emphasizes the role of systolic blood pressure as a major determinant of PPA .