Ultrastructural Cutaneous Microvascular Pathology of Young Adults Aged up to 50 Years with Chronic Kidney Disease and Vascular Cognitive Impairment

Arismendi-Morillo, Gabriel; Fernández-Abreu, Mary

doi:10.3109/01913121003743690

Cited by 7 publications

(5 citation statements)

References 18 publications

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“…[6][7][8][9][10][11][12][13] In patients with ESRD, the microvascular disorders are generalized, involving muscular, cutaneous, renal, and myocardial circulations. [37][38][39][40] Decreased postocclusion or thermal muscular and cutaneous hyperemia was observed in patients with ESRD and associated with cardiovascular risk and increased mortality. 36,37,40 These abnormalities reflect reduced microvascular and capillary density, abnormal vessel recruitment, structural changes of the microvasculature, and endothelial dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…36,37,40 These abnormalities reflect reduced microvascular and capillary density, abnormal vessel recruitment, structural changes of the microvasculature, and endothelial dysfunction. [36][37][38][39][40] In the investigation, the effect of aortic and arterial changes on outcomes of patients with ESRD was studied using Cox models and receiver operating characteristic curves ( Figure 5, Tables 6 and 7). The only arterial parameters associated with all-cause and cardiovascular mortality are increased aortic PWV and aortic bifurcation diameter, which are both significantly associated with premature arterial aging in ESRD.…”

Section: Discussionmentioning

confidence: 99%

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Aortic Aging in ESRD: Structural, Hemodynamic, and Mortality Implications

London

Safar

Pannier

2015

JASN

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Aging incurs aortic stiffening and dilation, but these changes are less pronounced in peripheral arteries, resulting in stiffness and geometry gradients influencing progression of the forward and reflected pressure waves. Because premature arterial aging is observed in ESRD, we determined the respective roles of stiffness and aortic geometry gradients in 73 controls and 156 patients on hemodialysis. We measured aortic pulse wave velocity (PWV) and brachial PWV to evaluate the stiffness gradient [(brachial PWV/aortic PWV) 0.5 ] and ascending aortic and aortic bifurcation diameters to assess aortic taper (ascending aortic diameter/aortic bifurcation diameter). The global reflection coefficient was estimated from characteristic impedance and vascular resistance. Cox proportional hazard models were used to determine mortality risk. The age-associated increase in aortic PWV was higher in patients (P,0.001). In controls, aortic ascending and bifurcation diameters increased with age, with an unchanged aortic taper. In patients on hemodialysis, age did not associate with increased ascending aortic diameter but did associate with increased aortic bifurcation diameter and decreased aortic taper, both of which also associated with abdominal aortic calcifications and smaller global reflection coefficient (P,0.001). In patients, multivariate models revealed all-cause and cardiovascular mortality associated with age, aortic PWV, and aortic bifurcation diameter with high specificity and sensitivity. Using stiffness gradient, aortic taper, or global reflection coefficient in the model produced similar results. Thus, whereas aortic stiffness is a known independent predictor of mortality, these results indicate the importance of also evaluating the aortic geometry in patients on hemodialysis. 27: 183727: -184627: , 201627: . doi: 10.1681 Aging is associated with marked changes in the mechanical and geometric characteristics of the arterial tree. 1 It is characterized by markedly increased aortic stiffness (aortic pulse wave velocity [PWV]), stiffening not observed to the same degree in peripheral muscular arteries. 2 This change reduces the normal centrifugal impedance gradient between central and peripheral artery systems. 2,3 Any change of the impedance gradient generates modifications of partial local wave reflections, which can be considered a continuous phenomenon along the impedance gradient. 3,4 The partial reflections summate to form an apparently unique backward-traveling reflected wave. 5 In the presence of impedance gradient and low aortic PWV, the backward wave returns to the aorta at end systole and early diastole, thereby enhancing late diastolic pressure and coronary perfusion 4 and attenuating the transmission of pulsatile pressure to the microcirculation. 3,6 The central effect of aortic stiffness on impedance J Am Soc Nephrol

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Aortic Aging in ESRD: Structural, Hemodynamic, and Mortality Implications

London

Safar

Pannier

2015

JASN

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“…Cerebral desaturation is associated with a higher risk of postoperative cognitive impairment (59,60) and may occur despite adequate mean arterial pressure and global hemodynamics, being induced, for example, by inadvertent hyperventilation and the cerebral vasoconstriction that accompanies it. This insult should be avoided, where possible, in the CKD population who are already at increased risk of vascular‐origin cognitive impairment (61).…”

Section: Microvascular Resuscitation and Correction Of Tissue Dysoxiamentioning

confidence: 99%

Perioperative Management of the Hemodialysis Patient

Trainor¹,

Borthwick²,

Ferguson³

2011

Seminars in Dialysis

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Dialysis-dependent chronic kidney disease (CKD) is an expanding problem for healthcare systems worldwide. The prevalence of end-stage renal disease (ESRD) has increased by 20% since 2000 and stands at 1699 per million people in the USA. ESRD is associated with an increased risk of cardiovascular comorbidity, increased severity of cardiovascular disease, and an adjusted all-cause mortality rate that is 6.4-7.8-fold higher than the general population. These patients may present electively or emergently for surgery related to, or remote from, the CKD. In any perioperative setting, the patient with hemodialysis-dependent CKD represents a significant clinical challenge, and successful management of these patients requires effective cooperation and communication between nephrology, anesthesia, and surgical staff. The ESRD patient's nephrologist will have the best knowledge of their medical history, comorbidities, and future management goals and may have been the clinician who instigated the referral for the surgery, e.g., for parathyroidectomy, vascular access surgery, nephrectomy or renal transplantation. As such, they are in an ideal position to contribute to, or coordinate, early preoperative medical optimization of the patient and also to provide advice during postoperative recovery and rehabilitation. In this article, we provide an overview of some of the key aspects of managing these patients successfully during the perioperative period. We propose the integration of cardiopulmonary exercise testing and cardiovascular optimization into the care of these high-risk patients and provide an overview of the importance of maintaining microvascular perfusion and the role of viscosity in preserving the capillary perfusion network.

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“…The pathways by which these white matter lesions may develop are unclear. One hypothesis is that kidney disease is a marker for small vessel disease which may be present both in kidneys and the brain [24]. This would perhaps explain the cross-sectional association found, but not why some evidence for this association remained after adjustment for relevant biomarkers and preceding health behaviours that are associated with small vessel disease in the general population.…”

Section: Discussionmentioning

confidence: 99%

Cognitive and Kidney Function: Results from a British Birth Cohort Reaching Retirement Age

et al. 2014

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BackgroundPrevious studies have found associations between cognitive function and chronic kidney disease. We aimed to explore possible explanations for this association in the Medical Research Council National Survey of Health and Development, a prospective birth cohort representative of the general British population.MethodsCognitive function at age 60–64 years was quantified using five measures (verbal memory, letter search speed and accuracy, simple and choice reaction times) and glomerular filtration rate (eGFR) at the same age was estimated using cystatin C. The cross-sectional association between cognitive function and eGFR was adjusted for background confounding factors (socioeconomic position, educational attainment), prior cognition, and potential explanations for any remaining association (smoking, diabetes, hypertension, inflammation, obesity).ResultsData on all the analysis variables were available for 1306–1320 study members (depending on cognitive measure). Verbal memory and simple and choice reaction times were strongly associated with eGFR. For example, the lowest quartile of verbal memory corresponded to a 4.1 (95% confidence interval 2.0, 6.2) ml/min/1.73 m2 lower eGFR relative to the highest quartile. Some of this association was explained by confounding due to socioeconomic factors, but very little of it by prior cognition. Smoking, diabetes, hypertension, inflammation and obesity explained some but not all of the remaining association.ConclusionsThese analyses support the notion of a shared pathophysiology of impaired cognitive and kidney function at older age, which precedes clinical disease. The implications of these findings for clinical care and research are important and under-recognised, though further confirmatory studies are required.

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Ultrastructural Cutaneous Microvascular Pathology of Young Adults Aged up to 50 Years with Chronic Kidney Disease and Vascular Cognitive Impairment

Cited by 7 publications

References 18 publications

Aortic Aging in ESRD: Structural, Hemodynamic, and Mortality Implications

Aortic Aging in ESRD: Structural, Hemodynamic, and Mortality Implications

Perioperative Management of the Hemodialysis Patient

Cognitive and Kidney Function: Results from a British Birth Cohort Reaching Retirement Age

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