Arterial Stiffness in Chronic Kidney Disease: The Usefulness of a Marker of Vascular Damage

Bellasi, Antonio; Ferramosca, Emiliana; Ratti, Carlo

doi:10.4061/2011/734832

Cited by 25 publications

(21 citation statements)

References 29 publications

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“…The use of a variety of circulating and genetic biomarkers has offered improved CKD detection and risk prediction [11]. Tissue derived biomarkers provide utility as indicators of accumulated damage, such as damage to the vasculature resulting from non-traditional CKD risk factors [12][13][14][15][16], however they are typically less amenable to non-invasive assessment [17].…”

Section: Introductionmentioning

confidence: 99%

Association of reduced inner retinal thicknesses with chronic kidney disease

Paterson¹,

Ravindran²,

Griffiths³

et al. 2020

BMC Nephrol

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Background: Tissue derived biomarkers may offer utility as indicators of accumulated damage. Reduced thickness of retinal neuronal tissue and the vascular choroid have previously been associated with vascular damage and diabetes. We evaluated associations between retinal thickness, retinal microvascular and choroidal measures, and renal function in a population with a high burden of comorbidity. Methods: Participants were recruited from nuclear cardiology or renal medicine clinics. Retinal and choroidal thickness were measured from spectral-domain optical coherence tomograms. Retinal microvascular parameters were assessed from digital fundus photographs using a semi-automated software package. Main Outcome Measure: Chronic kidney disease (CKD) categorised as: CKD stages 1-2, eGFR ≥60 ml/min/1.73m 2 ; CKD stage 3, eGFR 30-59 ml/min/1.73m 2 , and CKD stages 4-5, eGFR ≤29 ml/min/1.73m 2. Results: Participants (n = 241) had a mean age of 65 years and a mean eGFR of 66.9 ml/min/1.73m 2. Thirty-nine % of the cohort had diabetes and 27% were using diuretics. Thinning of the inner retina and changes to its microvascular blood supply were associated with lower eGFR and CKD stages 4 and 5, while no associations were found between the outer retinal layers or their choroidal blood supply and CKD of any stage. These associations remained following adjustment for age, mean arterial blood pressure, diabetes status, low-density lipoprotein, body mass index, and sex. Conclusions: Inner retinal thinning and retinal microvascular variation is associated with advanced CKD (stages 4 & 5) independent of important confounding factors, but not with earlier stage CKD (stage 3) and, therefore, its utility as a biomarker for early CKD is not supported in this study.

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Section: Introductionmentioning

confidence: 99%

Association of reduced inner retinal thicknesses with chronic kidney disease

Paterson¹,

Ravindran²,

Griffiths³

et al. 2020

BMC Nephrol

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“…Furthermore, this significant association remained consistent with a high odds ratio even after controlling for potential confounders. Although not precisely determined, endothelial damage is probably a major cause of MAU [10,34]. For instance, MAU becomes fixed when progression of vascular structural changes starts including glomerulosclerosis, and endothelial dysfunction could lead to the development of MAU [10], which supports the notion that MAU reflects vascular damage in diabetic patients [35,36].…”

Section: Discussionmentioning

confidence: 66%

Association between Brachial-Ankle Pulse Wave Velocity and Microalbuminuria and to Predict the Risk for the Development of Microalbuminuria Using Brachial-Ankle Pulse Wave Velocity Measurement in Type 2 Diabetes Mellitus Patients

et al. 2019

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Brachial-ankle pulse wave velocity (baPWV) provides a useful means of assessing cardiovascular events and diabetic complications. However, the nature of associations between baPWV and microalbuminuria (MAU) and its presence in Type 2 diabetes mellitus (Type 2 DM) have rarely been investigated. This study aimed to examine the association between baPWV and MAU coupled with prediction of MAU using baPWV measurement among Type 2 DM patients. In this cross-sectional study, we enrolled 424 Type 2 DM patients who visited the cardiology and endocrinology department at a tertiary level health care facility, Republic of Korea between 1 January 2006 to 31 December 2008. Clinical and laboratory data were collected, and risk factors associated with MAU and prediction of risk for the development of MAU using baPWV measurement. The association between MAU and baPWV was examined using multivariable logistic regression analysis and predicted MAU by using receiver operating characteristic (ROC) curve analysis. Of the 424 Type 2 DM patients, 93 (21.9%) had MAU (20–200 μg/min). baPWV (cm/sec) was found to be significantly correlated with MAU levels (ug/min) (r = 0.791, p < 0.001). Further, baPWV was significantly associated MAU with higher odds ratio (adjusted odds ratio (AOR) 10.899; 95% confidence interval (CI) (4.518–26.292)). Similarly, smoking (AOR 5.736; 95% CI (1.036–31.755)), and low-density lipoprotein (LDL)-cholesterol (mg/dL) (AOR 1.017; 95% CI (1.001–1.033)) were also significantly associated with MAU. The appropriate cut-off value for baPWV to predict MAU 20 μg/min in our study was 1700 cm/sec (area under ROC curve = 0.976). This study shows that baPWV, cigarette smoking, and LDL-cholesterol are associated with MAU in Type 2 DM patients and suggests that a baPWV cut-off of 1700 cm/sec could be used to predict the presence of MAU (20 μg/min) in Type 2 DM patients in the Korean community.

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“…In CKD patients, additional mechanisms are probably responsible for raised aPWV . Bellasi suggested that exposure to traditional and nontraditional cardiovascular risk factors leads to arterial wall remodeling and reduced arterial compliance. All these changes negatively affect the process that converts pulsatile into continuous blood flow, impairing the oxygen supply to peripheral tissues.…”

Section: Discussionmentioning

confidence: 99%

Radiographic Assessment of Vascular Calcification, Aortic Pulse Wave Velocity, Ankle‐Brachial Index and Fibroblast Growth Factor‐23 in Chronic Hemodialysis Patients

et al. 2013

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Vascular calcification is a frequent complication of chronic kidney disease and end stage renal disease. In both the general population and patients with end stage renal disease, vascular calcification is related to arterial stiffness and is a predictor of cardiovascular morbidity and mortality. Various diagnostic methods are currently used to assess vascular calcification. There is a preference for simple, reliable methods that can be used in daily practice. Therefore, several imaging and laboratory methods are investigated. Twenty-eight patients with mean age of 62 years on chronic hemodialysis were enrolled in the study. The mean duration of hemodialysis treatment was 70 months (range 3 to 350 months). Vascular calcification was assessed with coronary computed tomography and lateral lumbar, pelvic and hand radiographs. Vascular stiffness was evaluated using aortic pulse wave velocity and ankle-brachial index measurements, and finally serum levels of fibroblast growth factor-23 were followed. A statistically significant correlation was demonstrated between all the following parameters: coronary artery calcification score, aortic pulse wave velocity, abdominal aortic calcification score, simple vascular calcification scores in pelvis and hand. A statistically significant correlation of ankle-brachial index >1.3 to coronary artery calcification score was found. There was no correlation between the previous parameters and fibroblast growth factor-23. The results of our study indicate that simple imaging methods could provide confident vascular damage assessment and therefore potentially guide therapy adjustments. An association between fibroblast growth factor-23 and the other diagnostic modalities in our study was not found.

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Arterial Stiffness in Chronic Kidney Disease: The Usefulness of a Marker of Vascular Damage

Cited by 25 publications

References 29 publications

Association of reduced inner retinal thicknesses with chronic kidney disease

Association of reduced inner retinal thicknesses with chronic kidney disease

Association between Brachial-Ankle Pulse Wave Velocity and Microalbuminuria and to Predict the Risk for the Development of Microalbuminuria Using Brachial-Ankle Pulse Wave Velocity Measurement in Type 2 Diabetes Mellitus Patients

Radiographic Assessment of Vascular Calcification, Aortic Pulse Wave Velocity, Ankle‐Brachial Index and Fibroblast Growth Factor‐23 in Chronic Hemodialysis Patients

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