SAGE-Hindawi Access to Research International Journal of Nephrology Volume 2011, Article ID 427471, 6 pages doi:10.4061/2011/427471 Clinical Study Effects of Moderate-to-Severe Impairment of the Estimated Glomerular Filtration Rate and of Proteinuria on the Central Hemodynamics and Arterial Stiffness in Middle-Aged Healthy Japanese Men Hirofumi Tomiyama, Mari Odaira, Chisa Matsumoto, Jiko Yamada, Masanobu Yoshida, Kazuki Shiina, and Akira Yamashina Second Department of Internal Medicine, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Tokyo 160-0023, Japan Correspondence should be addressed to Hirofumi Tomiyama, tomiyama@tokyo-med.ac.jp Received 30 December 2010; Accepted 16 January 2011 Academic Editor: Hiromichi Suzuki Copyright © 2011 Hirofumi Tomiyama et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We evaluated the eﬀects of moderate-to-severe impairment of the estimated glomerular ﬁltration rate (eGFR: 15 to 59 mL/min per 1.73 m2) and of proteinuria on the central hemodynamics and the pulse wave velocity (PWV) in 2244 middle-aged healthy Japanese men who were not receiving any medications for cardiovascular diseases or cardiovascular risk factors. The adjusted value of the radial augmentation index was higher in the subjects with proteinuria than in those without proteinuria. On the other hand, this value was similar between the subjects with and without moderate-to-severe impairment of the eGFR. Not only proteinuria but also moderate-to-severe impairment of the eGFR was associated with increase in the adjusted value of the brachial-ankle PWV. Thus, proteinuria was found to be an independent risk factor for abnormal central hemodynamics and increased stiﬀness of the large- to middle-sized arteries, while moderate-to-severe impairment of the eGFR was associated with an increase of the arterial stiﬀness, but not with abnormality of the central hemodynamics. 1. Introduction Chronic kidney disease (CKD) is an independent risk factor for cardiovascular disease [1–3]. Assessment of the severity of CKD is employed in general health checkups for cardiovas- cular risk stratiﬁcation [1–3]. Estimated glomerular ﬁltration rate (eGFR) (mL/min per 1.73 m2) and presence/absence of proteinuria are the key components measured during assessment of the severity of CKD. A recent meta-analysis demonstrated that the central hemodynamics (i.e., augmen- tation index (AI) and central blood pressure (CBP)) and pulse wave velocity (PWV), a marker of the stiﬀness of large arteries, are independent risk factors for cardiovascular disease and that these variables may reﬂect diﬀerent facets of the pathophysiological abnormalities related to arterial stiﬀness [4, 5]. Several studies have demonstrated abnormal central hemodynamics and increased PWV in subjects with end-stage renal disease (i.e., eGFR <15 mL/min per 1.73 m2) [6, 7]. On the other hand, it has not yet been clearly revealed whether moderate-to-severe impairment of the eGFR (15 to 59 mL/min per 1.73 m2) and proteinuria may also be associated with impairment of the central hemodynamics and increase of the PWV [8, 9]. One of the reasons for the inconclusiveness of this issue may be related to the medications prescribed to the study subjects, because the medications prescribed for the cardiovascular risk factors are known to potentially aﬀect the central hemodynamics and PWV [10]. Recently, we reported several ﬁndings of clinical studies conducted by us on the arterial stiﬀness [11, 12]. Our study subjects mostly comprised middle-aged healthy Japanese men and revealed gender diﬀerences in the central hemo- dynamic variables [13]. The present study was conducted to evaluate the eﬀects of moderate-to-severe impairment of