Document Detail


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.
MedLine Citation:
PMID:  21376323     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 co-morbidity, 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.
Authors:
Pajaree Lilitkarntakul; Neeraj Dhaun; Vanessa Melville; Scott Blackwell; Dinesh K Talwar; Barbara Liebman; Takae Asai; Jennifer Pollock; Jane Goddard; David J Webb
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-03-03
Journal Detail:
Title:  Atherosclerosis     Volume:  216     ISSN:  1879-1484     ISO Abbreviation:  Atherosclerosis     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-05-06     Completed Date:  2011-08-23     Revised Date:  2014-01-23    
Medline Journal Info:
Nlm Unique ID:  0242543     Medline TA:  Atherosclerosis     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  217-25     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Adult
Analysis of Variance
Arginine / analogs & derivatives,  blood
Biological Markers / blood
Blood Pressure*
Brachial Artery / physiopathology*
C-Reactive Protein / analysis
Carotid Arteries / physiopathology*
Case-Control Studies
Chronic Disease
Comorbidity
Compliance
Cross-Sectional Studies
Disease Progression
Endothelin-1 / blood
Endothelium, Vascular / physiopathology*
Female
Femoral Artery / physiopathology*
Glomerular Filtration Rate
Humans
Isoprostanes / blood
Kidney / physiopathology
Kidney Diseases / blood,  epidemiology,  physiopathology*
Linear Models
Male
Middle Aged
Peripheral Arterial Disease / blood,  epidemiology,  physiopathology*
Prospective Studies
Pulsatile Flow
Risk Assessment
Risk Factors
Scotland / epidemiology
Uremia / epidemiology,  physiopathology*
Vasodilation*
Grant Support
ID/Acronym/Agency:
P01 HL069999/HL/NHLBI NIH HHS; PG/05/91//British Heart Foundation
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Endothelin-1; 0/Isoprostanes; 30315-93-6/N,N-dimethylarginine; 9007-41-4/C-Reactive Protein; 94ZLA3W45F/Arginine
Comments/Corrections
Comment In:
Atherosclerosis. 2011 Jun;216(2):275-6   [PMID:  21440893 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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