Regional Arterial Stiffness in Patients with Type 2 Diabetes and Chronic Kidney Disease

Abstract

Increased arterial stiffness is an independent predictor of death from cardiovascular disease, and aortic stiffness is more predictive than stiffness of other arterial regions. Because little is known about the effect of chronic kidney disease (CKD) on regional arterial stiffness, pulse wave velocity (PWV) of four different arterial segments was measured in patients who had type 2 diabetes with and without various stages of CKD. A total of 434 patients had type 2 diabetes, and there were 192 healthy control subjects who were comparable in age and gender. GFR was estimated by the abbreviated Modification of Diet in Renal Disease equation. The patients with diabetes were classified into CKD stages by the definition of the Kidney Disease Outcomes Quality Initiative guidelines. PWV was measured in the heart-femoral, heart-carotid, heart-brachial, and femoralankle segments simultaneously using an automatic pulse wave analyzer. PWV of each arterial region was increased in patients who had diabetes without kidney damage and was increased further in a stepwise manner with the advanced stages of CKD. The increase in PWV was greater in the heart-femoral and heart-carotid regions than in the heart-brachial and femoral-ankle segments. However, after adjustment for age, BP, and other confounding factors using a multiple regression model, decreased GFR was independently associated with increased PWV of the heart-femoral region but not with PWV of other arterial segments. In type 2 diabetes, CKD was associated with increased stiffness of arteries, particularly of the aorta. The cross-sectional result may explain the increased risk for cardiovascular disease in CKD, although longitudinal studies are needed to confirm it.

Brachial-ankle Pulse Wave Velocity as an Index of Central Arterial Stiffness

“…Previous studies 20,22) identified age, diabetes mellitus, and CKD as the factors preferentially associated with increased PWV of the aorta over other arterial segments. Thus, we examined whether baPWV shared such risk factors with aortic PWV in our subjects.…”

“…PWV and blood pressure measurements were performed in the supine position after 5 minutes of bed rest using an automatic waveform analyzer (model BP-203RPE; Colin, Komaki City, Japan) as previously described 20,22,25) . The ankle-brachial pressure index (ABI) was defined as the ratio of systolic blood pressure (SBP) of the tibial artery to that of the brachial artery.…”

“…A very recent report by Tanaka et al 16) showed that baPWV and carotid-femoral PWV were closely and comparably associated with blood pressure, the Framingham risk score (FRS), and pre-existing CVD. Previous studies [17][18][19][20][21][22] showed that the impact of some CVD risk factors and medications on PWV varies among different arterial territories. Also, the association of pre-existing CVD with PWV appears to vary among these regional PWV measurements [23][24][25] ; therefore, it is an important question whether baPWV is an index of central or peripheral arterial stiffness.…”

Chronic Kidney Disease, Dyslipidemia, and Atherosclerosis

“…Regarding the role of dyslipidemia in advanced atherosclerosis in patients with CKD, both carotid IMT 52,56) and aortic PWV 53,54,57) are reported to be positively associated with non-high-density lipoprotein cholesterol (non-HDL-C), independent of other risk factors in subjects with various degrees of CKD. Among non-HDL lipoproteins, IDL showed the closest association with aortic PWV in hemodialysis patients 53) .…”

Subclinical Lesion of Carotid Arteries in Chronic Glomerulonephritis

“…В этой связи, всё больше исследователей начинают обращать своё внимание на вопросы ранней диагно-стики и профилактики сосудистых осложнений при ХБП. В частности, в ряде работ показано, что при выраженной почечной дисфункции усиливается артериальная жесткость [17], повышается скорость пульсовой волны [11] и снижается эластичность магистральных сосудов [7]. Однако половые харак-теристики поражения каротидных артерий и их взаимосвязь с дисфункцией почек при ГН изучены недостаточно.…”