Εndothelial and microvascular function in CKD: Evaluation methods and associations with outcomes

Theodorakopoulou, Marieta; Δίπλα, Κωνσταντίνα; Zafeiridis, Andreas; Sarafidis, Pantelis

doi:10.1111/eci.13557

Cited by 9 publications

(5 citation statements)

References 189 publications

(333 reference statements)

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“…A possibility is that endothelial dysfunction could play a pivotal role in precipitating adverse outcomes in hypertension and prediabetes, contributing to functional decline in frail older adults. Indeed, albuminuria may denote endothelial dysfunction [ 35 , 61 , 62 ], a condition highly prevalent in both hypertension and CKD [ 33 , 34 , 36 , 37 , 63 , 64 ]. We also speculate that CKD patients may have vascular brain damage, exacerbating cognitive decline.…”

Section: Discussionmentioning

confidence: 99%

“…Albuminuria serves as a hallmark of kidney disease, subclinical cardiovascular issues, and organ damage in hypertension [ 18 – 27 ] amplifying the risk of pre-frailty, frailty, and cognitive decline in older adults [ 28 – 33 ]. Moreover, albuminuria may underlie endothelial dysfunction, prevalent in both hypertension and CKD [ 33 – 37 ]. Hence, in the present study we explored the association between albuminuria and cognitive impairment in frail older adults with prediabetes and CKD, assessing cognitive levels based on estimated glomerular filtration rate (eGFR).…”

Section: Introductionmentioning

confidence: 99%

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Frail hypertensive older adults with prediabetes and chronic kidney disease: insights on organ damage and cognitive performance - preliminary results from the CARYATID study

Santulli,

Visco,

Ciccarelli

et al. 2024

Cardiovasc Diabetol

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Background Hypertension and chronic kidney disease (CKD) pose significant public health challenges, sharing intertwined pathophysiological mechanisms. Prediabetes is recognized as a precursor to diabetes and is often accompanied by cardiovascular comorbidities such as hypertension, elevating the risk of pre-frailty and frailty. Albuminuria is a hallmark of organ damage in hypertension amplifying the risk of pre-frailty, frailty, and cognitive decline in older adults. We explored the association between albuminuria and cognitive impairment in frail older adults with prediabetes and CKD, assessing cognitive levels based on estimated glomerular filtration rate (eGFR). Methods We conducted a study involving consecutive frail older patients with hypertension recruited from March 2021 to March 2023 at the ASL (local health unit of the Italian Ministry of Health) of Avellino, Italy, followed up after three months. Inclusion criteria comprised age over 65 years, prior diagnosis of hypertension without secondary causes, prediabetes, frailty status, Montreal Cognitive Assessment (MoCA) score < 26, and CKD with eGFR > 15 ml/min. Results 237 patients completed the study. We examined the association between albuminuria and MoCA Score, revealing a significant inverse correlation (r: 0.8846; p < 0.0001). Subsequently, we compared MoCA Score based on eGFR, observing a significant difference (p < 0.0001). These findings were further supported by a multivariable regression analysis, with albuminuria as the dependent variable. Conclusions Our study represents the pioneering effort to establish a significant correlation between albuminuria and eGFR with cognitive function in frail hypertensive older adults afflicted with prediabetes and CKD.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Frail hypertensive older adults with prediabetes and chronic kidney disease: insights on organ damage and cognitive performance - preliminary results from the CARYATID study

Santulli,

Visco,

Ciccarelli

et al. 2024

Cardiovasc Diabetol

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“…CVD is the leading cause of death in patients with CKD [ 90 ]. Changes in biochemical parameters such as ICAM-1 and asymmetric dimethylarginine (ADMA) are frequently observed in patients with CKD and may indicate endothelial damage [ 91 ]. Patients with CKD have reduced FMD.…”

Section: Fmd In Patients With Cardiovascular Diseasementioning

confidence: 99%

Endothelial Function Assessment by Flow-Mediated Dilation Method: A Valuable Tool in the Evaluation of the Cardiovascular System

Mućka

Miodońska

Jakubiak

et al. 2022

IJERPH

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Cardiovascular diseases (CVDs) in the course of atherosclerosis are one of the most critical public health problems in the world. Endothelial cells synthesize numerous biologically active substances involved in regulating the functions of the cardiovascular system. Endothelial dysfunction is an essential element in the pathogenesis of atherosclerosis. Thus, the assessment of endothelial function in people without overt CVD allows for a more accurate estimate of the risk of developing CVD and cardiovascular events. The assessment of endothelial function is primarily used in scientific research, and to a lesser extent in clinical practice. Among the tools for assessing endothelial function, we can distinguish biochemical and physical methods, while physical methods can be divided into invasive and non-invasive methods. Flow-mediated dilation (FMD) is based on the ultrasound assessment of changes in the diameter of the brachial artery as a result of increased blood flow. FMD is a non-invasive, safe, and repeatable test, but it must be performed by qualified and experienced medical staff. The purpose of this paper is to present the literature review results on the assessment of endothelial function using the FMD method, including its methodology, applications in clinical practice and research, limitations, and future perspectives.

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“… 7 Meta-analyses of randomised controlled trials have shown that increased n-3 PUFA intake improved arterial stiffness, 8 lowered blood pressure, 9 and reduced plasma triglycerides. 10 11 Because endothelial dysfunction, hypertension, and dyslipidaemia are CKD risk factors, 12 13 14 n-3 PUFAs could protect against the development of CKD.…”

Section: Introductionmentioning

confidence: 99%

Association of omega 3 polyunsaturated fatty acids with incident chronic kidney disease: pooled analysis of 19 cohorts

Marklund

Huang

Rye

et al. 2023

BMJ

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Objective To assess the prospective associations of circulating levels of omega 3 polyunsaturated fatty acid (n-3 PUFA) biomarkers (including plant derived α linolenic acid and seafood derived eicosapentaenoic acid, docosapentaenoic acid, and docosahexaenoic acid) with incident chronic kidney disease (CKD). Design Pooled analysis. Data sources A consortium of 19 studies from 12 countries identified up to May 2020. Study selection Prospective studies with measured n-3 PUFA biomarker data and incident CKD based on estimated glomerular filtration rate. Data extraction and synthesis Each participating cohort conducted de novo analysis with prespecified and consistent exposures, outcomes, covariates, and models. The results were pooled across cohorts using inverse variance weighted meta-analysis. Main outcome measures Primary outcome of incident CKD was defined as new onset estimated glomerular filtration rate <60 mL/min/1.73 m 2 . In a sensitivity analysis, incident CKD was defined as new onset estimated glomerular filtration rate <60 mL/min/1.73 m 2 and <75% of baseline rate. Results 25 570 participants were included in the primary outcome analysis and 4944 (19.3%) developed incident CKD during follow-up (weighted median 11.3 years). In multivariable adjusted models, higher levels of total seafood n-3 PUFAs were associated with a lower incident CKD risk (relative risk per interquintile range 0.92, 95% confidence interval 0.86 to 0.98; P=0.009, I 2 =9.9%). In categorical analyses, participants with total seafood n-3 PUFA level in the highest fifth had 13% lower risk of incident CKD compared with those in the lowest fifth (0.87, 0.80 to 0.96; P=0.005, I 2 =0.0%). Plant derived α linolenic acid levels were not associated with incident CKD (1.00, 0.94 to 1.06; P=0.94, I 2 =5.8%). Similar results were obtained in the sensitivity analysis. The association appeared consistent across subgroups by age (≥60 v <60 years), estimated glomerular filtration rate (60-89 v ≥90 mL/min/1.73 m 2 ), hypertension, diabetes, and coronary heart disease at baseline. Conclusions Higher seafood derived n-3 PUFA levels were associated with lower risk of incident CKD, although this association was not found for plant derived n-3 PUFAs. These results support a favourable role for seafood derived n-3 PUFAs in preventing CKD.

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Εndothelial and microvascular function in CKD: Evaluation methods and associations with outcomes

Cited by 9 publications

References 189 publications

Frail hypertensive older adults with prediabetes and chronic kidney disease: insights on organ damage and cognitive performance - preliminary results from the CARYATID study

Frail hypertensive older adults with prediabetes and chronic kidney disease: insights on organ damage and cognitive performance - preliminary results from the CARYATID study

Endothelial Function Assessment by Flow-Mediated Dilation Method: A Valuable Tool in the Evaluation of the Cardiovascular System

Association of omega 3 polyunsaturated fatty acids with incident chronic kidney disease: pooled analysis of 19 cohorts

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