Kidney function decline mediates the adverse effects of arterial stiffness on all-cause and cardiovascular disease mortality in Cardiovascular-Kidney-Metabolic syndrome population: A cohort study
Authors' conclusion
Elevated ePWV predicts increased mortality in CKM syndrome patients, with kidney function decline as a significant mediating pathway. These findings highlight the importance of arterial stiffness assessment and renal protection in CKM management.
Study context
- Population
- Cardiovascular-Kidney-Metabolic (CKM) syndrome patients from NHANES 1999–2018
- Participants
- 34,004 patients
- Exposure
- Per unit increase in estimated pulse wave velocity
- Outcome
- All-cause and CVD mortality
- Follow-up
- Median 104 months
Methodological detailsNHANES 1999-2018, mediation analysis
- NHANES 1999-2018
- Mediation analysis
Main finding
As reported in the abstract
Mortality per unit ePWV increase
All-cause deaths
4,141
CVD deaths
1,261
All-cause mortality per unit estimated pulse wave velocity (ePWV) increase, HR
1.32 (1.29-1.35) (95% CI)
CVD mortality per unit ePWV increase, HR
1.34 (1.28-1.40) (95% CI)
Observational data: associations, not effects.
Further findings
Shape of ePWV-mortality association
- L-shaped in non-advanced CKM; linear in advanced stages
Mediation by kidney function decline
%
- Proportion of all-cause mortality risk mediated
- 24
- Proportion of CVD mortality risk mediated
- 26
Original publication
Kidney function decline mediates the adverse effects of arterial stiffness on all-cause and cardiovascular disease mortality in Cardiovascular-Kidney-Metabolic syndrome population: A cohort study. Diabetes Res Clin Pract. Published 11 December 2025. doi:10.
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