J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://jocmr.elmerjournals.com

Original Article

Volume 18, Number 4, April 2026, pages 234-242

Usefulness of Blood Rheology as a Predictor of Primary Cardiovascular Disease Events in Patients With Stage G3 Chronic Kidney Disease

↓ Figure 1. Prediction value of MACEs incidence at follow-up period using WBPT. Receiver operating characteristic curve analysis indicated that a cut-off value for WBPT of 74.3 s yielded the largest area under the curve to predict MACEs. Arrows indicate the optimal cut-off point. MACEs: major adverse cardiovascular events; WBPT: whole blood passage time.

↓ Figure 2. Kaplan–Meier curve analysis for the incidence of MACEs. The Kaplan–Meier curve confirmed that group H had a significantly higher incidence of MACEs compared with group L (log-rank test, P < 0.001). MACEs: major adverse cardiovascular events.

↓ **Table 1.** Clinical Characteristics of the Studied Groups
Characteristics	Overall	Group L	Group H	P value
Continuous variables were expressed as means and standard deviations or median (interquartile range). AF: autofluorescence; AU: arbitrary unit; DPP-4: dipeptidyl peptidase-4; eGFR: estimated glomerular filtration rate; FBG: fasting blood glucose; HDL: high-density lipoprotein; hs-CRP: high-sensitivity C-reactive protein; LDL: low-density lipoprotein; r-AIx: radial augmentation index; RAS: renin–angiotensin system; WBPT: whole blood passage time.
n (male/female)	417 (144/273)	255 (91/164)	162 (53/109)	0.535
Age (years)	72 ± 12	71 ± 10	75 ± 13	0.062
WBPT (s)	68.6 ± 11.1	55.9 ± 11.0	88.5 ± 11.2	< 0.001
Risk factors
Obesity, n (%)	124 (30)	76 (30)	48 (30)	0.964
Current smoker, n (%)	74 (18)	36 (14)	38 (24)	0.014
Hypertension, n (%)	298 (72)	181 (71)	117 (72)	0.785
Dyslipidemia, n (%)	293 (70)	178 (70)	115 (71)	0.797
Diabetes mellitus, n (%)	134 (32)	67 (26)	67 (41)	0.001
Clinical parameters
eGFR (mL/min/1.73 m²)	47 ± 6	50 ± 6	44 ± 5	< 0.001
LDL cholesterol (mg/dL)	129 ± 35	128 ± 35	131 ± 35	0.414
Triglyceride (mg/dL)	122 ± 66	108 ± 61	143 ± 67	< 0.001
HDL cholesterol (mg/dL)	62 ± 15	64 ± 14	59 ± 14	0.001
FBG (mg/dL)	116 ± 27	114 ± 27	119 ± 27	0.125
hs-CRP (mg/L)	0.80 (0.30–1.50)	0.70 (0.30–1.20)	0.86 (0.29–1.97)	0.055
Skin AF (AU)	2.7 ± 0.5	2.6 ± 0.5	2.8 ± 0.5	< 0.001
Albuminuria, n (%)	213 (51)	111 (44)	102 (63)	< 0.001
r-AIx (%)	87 ± 11	85 ± 9	89 ± 12	< 0.001
Medication
RAS inhibitor, n (%)	156 (37)	106 (42)	50 (31)	0.027
Statin, n (%)	148 (36)	96 (38)	52 (32)	0.249
Sulfonylurea, n (%)	77 (19)	45 (18)	32 (20)	0.591
Metformin, n (%)	62 (15)	35 (14)	27 (17)	0.412
DPP-4 inhibitor, n (%)	75 (18)	41 (16)	34 (21)	0.204

↓ Table 1. Clinical Characteristics of the Studied Groups

Characteristics

Overall

Group L

Group H

P value

Continuous variables were expressed as means and standard deviations or median (interquartile range). AF: autofluorescence; AU: arbitrary unit; DPP-4: dipeptidyl peptidase-4; eGFR: estimated glomerular filtration rate; FBG: fasting blood glucose; HDL: high-density lipoprotein; hs-CRP: high-sensitivity C-reactive protein; LDL: low-density lipoprotein; r-AIx: radial augmentation index; RAS: renin–angiotensin system; WBPT: whole blood passage time.

n (male/female)

417 (144/273)

255 (91/164)

162 (53/109)

0.535

Age (years)

72 ± 12

71 ± 10

75 ± 13

0.062

WBPT (s)

68.6 ± 11.1

55.9 ± 11.0

88.5 ± 11.2

< 0.001

Risk factors

Obesity, n (%)

124 (30)

76 (30)

48 (30)

0.964

Current smoker, n (%)

74 (18)

36 (14)

38 (24)

0.014

Hypertension, n (%)

298 (72)

181 (71)

117 (72)

0.785

Dyslipidemia, n (%)

293 (70)

178 (70)

115 (71)

0.797

Diabetes mellitus, n (%)

134 (32)

67 (26)

67 (41)

0.001

Clinical parameters

eGFR (mL/min/1.73 m²)

47 ± 6

50 ± 6

44 ± 5

< 0.001

LDL cholesterol (mg/dL)

129 ± 35

128 ± 35

131 ± 35

0.414

Triglyceride (mg/dL)

122 ± 66

108 ± 61

143 ± 67

< 0.001

HDL cholesterol (mg/dL)

62 ± 15

64 ± 14

59 ± 14

0.001

FBG (mg/dL)

116 ± 27

114 ± 27

119 ± 27

0.125

hs-CRP (mg/L)

0.80 (0.30–1.50)

0.70 (0.30–1.20)

0.86 (0.29–1.97)

0.055

Skin AF (AU)

2.7 ± 0.5

2.6 ± 0.5

2.8 ± 0.5

< 0.001

Albuminuria, n (%)

213 (51)

111 (44)

102 (63)

< 0.001

r-AIx (%)

87 ± 11

85 ± 9

89 ± 12

< 0.001

Medication

RAS inhibitor, n (%)

156 (37)

106 (42)

50 (31)

0.027

Statin, n (%)

148 (36)

96 (38)

52 (32)

0.249

Sulfonylurea, n (%)

77 (19)

45 (18)

32 (20)

0.591

Metformin, n (%)

62 (15)

35 (14)

27 (17)

0.412

DPP-4 inhibitor, n (%)

75 (18)

41 (16)

34 (21)

0.204

↓ **Table 2.** Parameters at Registration of Patients With and Without MACEs
Characteristics	MACEs (−)	MACEs (+)	P value
Continuous values are mean ± SD. AF: autofluorescence; AU: arbitrary unit; DPP-4: dipeptidyl peptidase-4; eGFR: estimated glomerular filtration rate; FBG: fasting blood glucose; HDL: high-density lipoprotein; hs-CRP: high-sensitivity C-reactive protein; LDL: low-density lipoprotein; MACEs: major adverse cardiovascular events; r-AIx: radial augmentation index; RAS: renin–angiotensin system.
n (male/female)	343 (119/224)	74 (25/49)	0.798
Age (years)	71 ± 12	77 ± 11	< 0.001
Obesity, n (%)	104 (30)	20 (27)	0.575
Current smoker, n (%)	57 (17)	17 (22)	0.051
Hypertension, n (%)	240 (70)	58 (78)	0.147
Dyslipidemia, n (%)	242 (71)	51 (69)	0.780
Diabetes mellitus, n (%)	89 (26)	45 (61)	< 0.001
eGFR (mL/min/1.73 m²)	48 ± 6	44 ± 7	< 0.001
LDL cholesterol (mg/dL)	129 ± 34	130 ± 35	0.691
Triglyceride (mg/dL)	119 ± 66	139 ± 62	0.051
HDL cholesterol (mg/dL)	63 ± 15	59 ± 14	0.072
FBG (mg/dL)	114 ± 27	116 ± 27	< 0.001
hs-CRP (mg/L)	0.80 (0.30–1.50)	0.80 (0.27–1.60)	0.624
Skin AF (AU)	2.6 ± 0.5	3.0 ± 0.5	< 0.001
Albuminuria n (%)	162 (47)	51 (69)	< 0.001
r-AIx	86 ± 10	93 ± 11	< 0.001
RAS inhibitor, n (%)	140 (41)	21 (21)	0.002
Statin, n (%)	127 (37)	21 (28)	0.159
Sulfonylurea, n (%)	63 (18)	14 (19)	0.912
Metformin, n (%)	50 (15)	12 (16)	0.720
DPP-4 inhibitor, n (%)	58 (17)	17 (23)	0.219

↓ Table 2. Parameters at Registration of Patients With and Without MACEs

Characteristics

MACEs (−)

MACEs (+)

P value

Continuous values are mean ± SD. AF: autofluorescence; AU: arbitrary unit; DPP-4: dipeptidyl peptidase-4; eGFR: estimated glomerular filtration rate; FBG: fasting blood glucose; HDL: high-density lipoprotein; hs-CRP: high-sensitivity C-reactive protein; LDL: low-density lipoprotein; MACEs: major adverse cardiovascular events; r-AIx: radial augmentation index; RAS: renin–angiotensin system.

n (male/female)

343 (119/224)

74 (25/49)

0.798

Age (years)

71 ± 12

77 ± 11

< 0.001

Obesity, n (%)

104 (30)

20 (27)

0.575

Current smoker, n (%)

57 (17)

17 (22)

0.051

Hypertension, n (%)

240 (70)

58 (78)

0.147

Dyslipidemia, n (%)

242 (71)

51 (69)

0.780

Diabetes mellitus, n (%)

89 (26)

45 (61)

< 0.001

eGFR (mL/min/1.73 m²)

48 ± 6

44 ± 7

< 0.001

LDL cholesterol (mg/dL)

129 ± 34

130 ± 35

0.691

Triglyceride (mg/dL)

119 ± 66

139 ± 62

0.051

HDL cholesterol (mg/dL)

63 ± 15

59 ± 14

0.072

FBG (mg/dL)

114 ± 27

116 ± 27

< 0.001

hs-CRP (mg/L)

0.80 (0.30–1.50)

0.80 (0.27–1.60)

0.624

Skin AF (AU)

2.6 ± 0.5

3.0 ± 0.5

< 0.001

Albuminuria n (%)

162 (47)

51 (69)

< 0.001

r-AIx

86 ± 10

93 ± 11

< 0.001

RAS inhibitor, n (%)

140 (41)

21 (21)

0.002

Statin, n (%)

127 (37)

21 (28)

0.159

Sulfonylurea, n (%)

63 (18)

14 (19)

0.912

Metformin, n (%)

50 (15)

12 (16)

0.720

DPP-4 inhibitor, n (%)

58 (17)

17 (23)

0.219

↓ **Table 3.** Multivariate Cox Regression Analysis for MACEs
Variables	HR	95% CI	P value
AF: autofluorescence; AU: arbitrary unit; CI: confidence interval; eGFR: estimated glomerular filtration rate; HR: hazard ratio; MACEs: major adverse cardiovascular events; r-AIx: radial augmentation index; RAS: renin–angiotensin system.
Group H (vs. group L)	3.89	2.12–7.10	< 0.001
Diabetes mellitus	2.11	1.26–4.54	0.004
Age (≥ 75 years)	1.98	1.35–3.91	0.006
RAS inhibitor	0.51	0.27–0.88	0.018
Skin AF (≥ 2.7 AU)	1.95	1.12–3.40	0.019
r-AIx (≥ 88%)	1.78	1.03–3.10	0.041
Albuminuria	1.22	0.51–1.86	0.353
eGFR (stage 3A vs. stage 3B)	1.12	0.67–2.21	0.536

↓ Table 3. Multivariate Cox Regression Analysis for MACEs

Variables

95% CI

P value

AF: autofluorescence; AU: arbitrary unit; CI: confidence interval; eGFR: estimated glomerular filtration rate; HR: hazard ratio; MACEs: major adverse cardiovascular events; r-AIx: radial augmentation index; RAS: renin–angiotensin system.

Group H (vs. group L)

3.89

2.12–7.10

< 0.001

Diabetes mellitus

2.11

1.26–4.54

0.004

Age (≥ 75 years)

1.98

1.35–3.91

0.006

RAS inhibitor

0.51

0.27–0.88

0.018

Skin AF (≥ 2.7 AU)

1.95

1.12–3.40

0.019

r-AIx (≥ 88%)

1.78

1.03–3.10

0.041

Albuminuria

1.22

0.51–1.86

0.353

eGFR (stage 3A vs. stage 3B)

1.12

0.67–2.21

0.536