TY - JOUR
T1 - Blood pressure and not uraemia is the major determinant of arterial stiffness and endothelial dysfunction in patients with chronic kidney disease and minimal co-morbidity
AU - Lilitkarntakul, Pajaree
AU - Dhaun, Neeraj
AU - Melville, Vanessa
AU - Blackwell, Scott
AU - Talwar, Dinesh K.
AU - Liebman, Barbara
AU - Asai, Takae
AU - Pollock, Jennifer
AU - Goddard, Jane
AU - Webb, David J.
N1 - Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
PY - 2011/5/1
Y1 - 2011/5/1
N2 - Introduction: Patients with chronic kidney disease (CKD) have increased risk of cardiovascular disease to which co-morbidity and associated conventional risk factors contribute. We hypothesised that arterial stiffness (AS) and endothelial dysfunction (ED), as surrogates of cardiovascular risk, would worsen as renal function declined even in patients without co-morbidity and that this would relate to emerging cardiovascular risk factors.Methods: Carotid-femoral pulse wave velocity (PWV), as a measure of AS, and flow-mediated dilatation (FMD) of the brachial artery, as a measure of ED, were assessed in CKD patients without established cardiovascular disease or diabetes mellitus.Results: PWV increased linearly as renal function declined (r(2) = 0.08, p < 0.01) whereas FMD was reduced only in patients with advanced kidney disease. In multivariable analysis, blood pressure was the major determinant of PWV and FMD. High-sensitivity C-reactive protein and asymmetric dimethylarginine, and isoprostanes and endothelin-1, were independent predictors of PWV and FMD, respectively. However, renal function did not independently predict either AS or ED.Conclusions: These findings suggest that declining renal function, in the absence of significant comorbidity, is associated with progressive arterial stiffness, but only patients close to dialysis exhibit endothelial dysfunction. Whilst blood pressure remains the major determinant of PWV and FMD, inflammation, oxidative stress and endothelin-nitric oxide balance contribute to cardiovascular risk, in this non-comorbid cohort. (C) 2011 Elsevier Ireland Ltd. All rights reserved.
AB - Introduction: Patients with chronic kidney disease (CKD) have increased risk of cardiovascular disease to which co-morbidity and associated conventional risk factors contribute. We hypothesised that arterial stiffness (AS) and endothelial dysfunction (ED), as surrogates of cardiovascular risk, would worsen as renal function declined even in patients without co-morbidity and that this would relate to emerging cardiovascular risk factors.Methods: Carotid-femoral pulse wave velocity (PWV), as a measure of AS, and flow-mediated dilatation (FMD) of the brachial artery, as a measure of ED, were assessed in CKD patients without established cardiovascular disease or diabetes mellitus.Results: PWV increased linearly as renal function declined (r(2) = 0.08, p < 0.01) whereas FMD was reduced only in patients with advanced kidney disease. In multivariable analysis, blood pressure was the major determinant of PWV and FMD. High-sensitivity C-reactive protein and asymmetric dimethylarginine, and isoprostanes and endothelin-1, were independent predictors of PWV and FMD, respectively. However, renal function did not independently predict either AS or ED.Conclusions: These findings suggest that declining renal function, in the absence of significant comorbidity, is associated with progressive arterial stiffness, but only patients close to dialysis exhibit endothelial dysfunction. Whilst blood pressure remains the major determinant of PWV and FMD, inflammation, oxidative stress and endothelin-nitric oxide balance contribute to cardiovascular risk, in this non-comorbid cohort. (C) 2011 Elsevier Ireland Ltd. All rights reserved.
UR - http://www.scopus.com/inward/record.url?scp=79955539810&partnerID=8YFLogxK
U2 - 10.1016/j.atherosclerosis.2011.01.045
DO - 10.1016/j.atherosclerosis.2011.01.045
M3 - Article
C2 - 21376323
SN - 0021-9150
VL - 216
SP - 217
EP - 225
JO - Atherosclerosis
JF - Atherosclerosis
IS - 1
ER -