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Correlation of Pulse Wave Transit Time with Pulmonary Artery Pressure in a Porcine Model of Pulmonary Hypertension. Biomedicines 2021; 9:biomedicines9091212. [PMID: 34572397 PMCID: PMC8467418 DOI: 10.3390/biomedicines9091212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/27/2021] [Accepted: 09/06/2021] [Indexed: 11/17/2022] Open
Abstract
For the non-invasive assessment of pulmonary artery pressure (PAP), surrogates like pulse wave transit time (PWTT) have been proposed. The aim of this study was to invasively validate for which kind of PAP (systolic, mean, or diastolic) PWTT is the best surrogate parameter. To assess both PWTT and PAP in six healthy pigs, two pulmonary artery Mikro-Tip™ catheters were inserted into the pulmonary vasculature at a fixed distance: one in the pulmonary artery trunk, and a second one in a distal segment of the pulmonary artery. PAP was raised using the thromboxane A2 analogue U46619 (TXA) and by hypoxic vasoconstriction. There was a negative linear correlation between PWTT and systolic PAP (r = 0.742), mean PAP (r = 0.712) and diastolic PAP (r = 0.609) under TXA. During hypoxic vasoconstriction, the correlation coefficients for systolic, mean, and diastolic PAP were consistently higher than for TXA-induced pulmonary hypertension (r = 0.809, 0.778 and 0.734, respectively). Estimation of sPAP, mPAP, and dPAP using PWTT is feasible, nevertheless slightly better correlation coefficients were detected for sPAP compared to dPAP. In this study we establish the physiological basis for future methods to obtain PAP by non-invasively measured PWTT.
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Bhandari V, Sharma K, Shah P, Khan E, Desai HD, Vora T, Bhalla S, Gadhiya D, Bansal M, Kasliwal RR. Predictors of Arterial Stiffness Amongst the 24-Hour Ambulatory Blood Pressure Variables in Hypertensive Patients. Cureus 2020; 12:e12207. [PMID: 33500849 PMCID: PMC7818675 DOI: 10.7759/cureus.12207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective The objective of the study is to identify the predominant determinants of arterial stiffness as assessed by pulse-wave-velocity (PVW) amongst various 24-hour ambulatory blood pressure monitoring (ABPM) parameters in Indian hypertensive subjects. Method Subjects of both genders between 18-60 years with hypertension and who were either drug naïve or on stable anti-hypertensive treatment for at least three months were included in the study. All subjects underwent clinical evaluation with a medical history, biochemical investigations, and assessment of arterial stiffness by PWV along with 24-hour ABPM. Results We found the males were younger than females amongst hypertensive cohort (41.53 ± 10.89 years vs. 52.2 ± 5.17 years, respectively; p=0.001) and had shorter duration of hypertension (41.42 ± 49.14 months vs. 87.8 ± 74.55 months, respectively; p=0.012) and had lower 24-hour average pulse pressure (aPP; 49.1 ± 7.8 mm Hg vs. 57.83 ± 8.92 mm Hg, respectively; p=0.001) at baseline. Younger people (<40-years) as compared to those >40-years of age had the lower carotid-femoral (cf) PWV (972.8 ± 125.0 cm/sec vs. 1165.0 ± 208.4 cm/sec, respectively; p=0.001) and average brachial-ankle (ba) PWV (1413.7 ± 160.4 cm/sec and 1640.0 ± 227.1 cm/sec, respectively; p=0.001). Bivariate analysis revealed that amongst all the 24-hour ABPM parameters, 24-hour aPP had the strongest correlation (r=0.414, p=0.003) with arterial stiffness as assessed by PWV. Also, statistically significant correlation was found in age group <40 years between cf-PWV and both 24-hour aPP (r=0.54, p=0.025) as well as night-time aPP (r=0.59, p=0.013) Conclusion We conclude that 24-hour aPP showed the strongest correlation with arterial stiffness parameters and best correlated with arterial stiffness variables amongst 24-hour ABPM parameters, especially amongst subjects <40 years of age. The pulsatile blood pressure (BP) was a better predictor of aortic PWV than the continuous part of BP.
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Affiliation(s)
- Vishal Bhandari
- Interventional Cardiology, Tagore Hospital and Heart Care Center, Jalandhar, IND
| | - Kamal Sharma
- Cardiology Department, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, IND
| | - Purva Shah
- Medicine, B.J. Medical College, Ahmedabad, IND
| | - Erum Khan
- Medicine, B.J. Medical College, Ahmedabad, IND
| | - Hardik D Desai
- Internal Medicine, Gujarat Adani Institute of Medical Sciences, Krantiguru Shyamji Krishna Verma (KSKV) University, Bhuj, IND
| | - Tanisha Vora
- Graduate Medical Education, Smt. Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College, Ahmedabad, IND
| | - Sukriti Bhalla
- Cardiology, Akash Healthcare - Super Speciality Hospital, New Delhi, IND
| | - Dhruvkumar Gadhiya
- Graduate Medical Education, Smt. Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College, Ahmedabad, IND
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Sri-Amad R, Huipao N, Prasertsri P, Roengrit T. Aortic Pulse Wave Velocity, Ankle-Brachial Index, and Malondialdehyde in Older Adults with or without Metabolic Syndrome. Pulse (Basel) 2020; 8:31-39. [PMID: 32999876 DOI: 10.1159/000505838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/08/2020] [Indexed: 12/14/2022] Open
Abstract
Metabolic syndrome is an important health problem associated with both subclinical atherosclerosis and an increased risk of cardiovascular disease and it leads to an elevated total mortality. Aortic pulse wave velocity (aPWV) is widely used for noninvasive assessment of arterial stiffness. Ankle-brachial index (ABI) predicts peripheral arterial disease (PAD) of the lower extremities. In addition, malondialdehyde (MDA) is thought to be involved in the development of arterial stiffness. The present study aimed to: (1) compare aPWV, ABI, and MDA between participants with MetS and those without MetS and (2) investigate the correlation of aPWV and ABI with the components of MetS and MDA. A total of 48 Thai elderly subjects were divided into 2 groups (MetS and non-MetS) according to the parameters set by the International Diabetes Federation (IDF). aPWV and ABI were measured using the VaSera VS-1500 system (Fukuda Denshi Co., Tokyo, Japan). MDA was determined by spectrophotometry. aPWV and MDA were significantly higher in the MetS group compared to the participants in the non-MetS group (9.33 ± 2.72 vs. 7.95 ± 1.37 m/s, p = 0.03, and 0.74 ± 0.71 vs. 0.45 ± 0.20 μmol, p = 0.02, respectively). However, ABI did not differ between the groups. Analysis of the risk factors of aPWV in each group revealed that there were no statistical associations between the components of MetS and MDA and aPWV in both the MetS and the non-MetS groups. A high aPWV is more prevalent among patients with MetS than among those without MetS. Monitoring of aPWV might help to explore potential detection of vascular damage in the elderly.
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Affiliation(s)
- Ruchada Sri-Amad
- Department of Physiology, Faculty of Science, Prince of Songkla University, Songkhla, Thailand
| | - Nawiya Huipao
- Department of Physiology, Faculty of Science, Prince of Songkla University, Songkhla, Thailand
| | - Piyapong Prasertsri
- Faculty of Allied Health Sciences, Burapha University, Chonburi, Thailand.,Exercise and Nutrition Sciences and Innovation Research Unit, Burapha University, Chonburi, Thailand
| | - Thapanee Roengrit
- Department of Physiology, Faculty of Science, Prince of Songkla University, Songkhla, Thailand
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Tangvoraphonkchai K, Davenport A. Changes in aortic pulse wave velocity in peritoneal dialysis do not mirror changes in extracellular water measured by bioimpedance. Int J Artif Organs 2020; 44:85-91. [PMID: 32552371 DOI: 10.1177/0391398820931109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pulse wave velocity is a measurement of arterial stiffness and associated with increased cardiovascular mortality. Previous reports in peritoneal dialysis have linked increased pulse wave velocity with an expansion in extracellular water. As cardiovascular mortality is increased in peritoneal dialysis patient, we wished to determine whether changes in pulse wave velocity mirrored changes in extracellular water. METHODS We repeated aortic pulse wave velocity and bioimpedance-derived extracellular water measurements in peritoneal dialysis patients attending for assessment of peritoneal membrane function. RESULTS Sixty-six patients, 41 males (62.1%), mean age of 66.2 ± 13.9 years, median duration of peritoneal dialysis treatment (14.3 (3.1-31.9) months) had repeated measurement 6.4 (5.8-10.2) months apart, with no significant change in aortic pulse wave velocity (10.1 ± 3.2 to 9.9 ± 2.8 m/s). In univariate analysis, the initial aortic pulse wave velocity was associated with extracellular water (r = 0.26, p = 0.034) and serum N-terminal pro brain-type natriuretic peptide (r = 0.25, p = 0.04), and on follow-up, aortic pulse wave velocity with N-terminal pro brain-type natriuretic peptide (r = 0.31, p = 0.01). Aortic pulse wave velocity increased in 50% of patients, and these patients had greater serum C-reactive protein 3(2-10) versus 2(1-4) mg/L, and ferritin (778(444-1099) versus 585(313-811), p < 0.05), but there were no differences in either absolute or adjusted extracellular water. Both log C-reactive protein (odds ratio 4.7 (95% confidence limits 1.3-17.1), p = 0.019) and prescription of calcium channel blockers (odds ratio 4.9 (95% confidence limits 1.2-19.1), p = 0.024) were independently associated with an increase in aortic pulse wave velocity. CONCLUSION We did not find an independent association between a change in aortic pulse wave velocity and extracellular water, suggesting that changes in aortic stiffness in peritoneal dialysis patients are more complex than simply following changes in extracellular water.
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Affiliation(s)
| | - Andrew Davenport
- UCL Department for Nephrology, University College London, London, UK
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Covic A, Goldsmith DJ, Florea L, Gusbeth–Tatomir P, Covic M. The Influence of Dialytic Modality on Arterial Stiffness, Pulse Wave Reflections, and Vasomotor Function. Perit Dial Int 2020. [DOI: 10.1177/089686080402400412] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BackgroundMeasurements of aortic stiffness [aortic pulse wave velocity (PWV) and augmentation index (AIx)] have been established as powerful predictors of survival on hemodialysis (HD). Abnormal endothelial-dependent and endothelial-independent vascular reactivity and increased arterial stiffness are commonly described in HD patients. There is, however, a lack of information on the comparative impact of different renal replacement therapies (RRTs) on PWV and AIx, and how these different methods might influence endothelial-dependent abnormal vasodilatation.ObjectiveTo describe in a cross-sectional design arterial compliance and distensibility in continuous ambulatory peritoneal dialysis (CAPD) versus HD versus renal transplant (RTx) patients, compared with age- and blood pressure-matched essential hypertensive controls. The PWV and aortic AIx were determined from contour analysis of arterial waveforms recorded by applanation tonometry in 40 CAPD, 41 HD, 20 RTx patients (with normal serum creatinine), and 20 controls with essential hypertension (all normotensive under treatment). Endothelial-dependent and endothelial-independent vascular reactivities were assessed by changes in AIx following challenges with inhaled salbutamol and sublingual nitroglycerin respectively.ResultsCAPD patients had significantly stiffer arteries than all other categories. The PWV was 8.29 ± 1.09 m/second in CAPD patients, significantly higher ( p < 0.05) compared to HD subjects (7.19 ± 1.87 m/s). Both dialysis subgroups had significantly higher PWV values compared to RTx patients (6.59 ± 1.62 m/s) and essential hypertensive controls (6.34 ± 1.32 m/s), p < 0.05. The AIx had a profile similar to PWV in different RRTs. All groups with the exception of CAPD subjects had a significant decrease in AIx following salbutamol. Moreover, the vasodilatation induced by either nitroglycerin or salbutamol was significantly blunted compared to HD. Overall, both dialysis categories had more abnormal responses compared to RTx patients and essential hypertensive controls.ConclusionCAPD is associated with stiffer arteries and more profoundly abnormal endothelial-dependent vasomotor function, compared to matched HD subjects. These differences in arterial physical properties might explain differences seen in cardiac structure and function between the RRTs.
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Affiliation(s)
- Adrian Covic
- Dialysis and Transplantation, Parhon University Hospital, Iasi, Romania
| | | | - Laura Florea
- Dialysis and Transplantation, Parhon University Hospital, Iasi, Romania
| | | | - Maria Covic
- Dialysis and Transplantation, Parhon University Hospital, Iasi, Romania
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Tangvoraphonkchai K, Davenport A. Aortic Pulse Wave Velocity in Peritoneal Dialysis Patients Is Not Simply Associated with Extracellular Water Expansion. Kidney Blood Press Res 2019; 44:1423-1431. [PMID: 31715600 DOI: 10.1159/000503424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/16/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cardiac death is increased in peritoneal dialysis (PD) patients. Pulse wave velocity (PWV) is a measurement of arterial stiffness, and previous reports linked PWV to increased extracellular water (ECW). As cyclers and icodextrin are increasingly used, we wished to determine whether this association between PWV and ECW remains. METHODS We measured aortic PWV (aPWV) and bioimpedance (InBody, Seoul, South Korea) in consecutive PD patients attending for peritoneal membrane testing. RESULTS 189 patients were included, 62.4% male, mean age 63.1 ± 15.2 years, 45.3% diabetic, median dialysis duration 12.3 (6.5-25.1) months, 71.4% using cyclers, weight 73.0 ± 16.1 kg, systolic blood pressure 142 ± 21 mm Hg, aPWV 10.4 ± 5.1 m/s. aPWV was associated with pulse pressure (r = 0.26, p = 0.001), Davies comorbidity score (r = 0.18, p = 0.013), and N-terminal pro-brain-type natriuretic peptide (NTproBNP; r = 0.18, p = 0.011). Patients with aPWV ≥10 m/s were older (65.9 ± 13.6 vs. 60.1 ± 16.3 years, p < 0.01) with a higher ECW-to-total body water ratio (0.400 ± 0.012 vs. 0.396 ± 0.013, p < 0.05), but ECW/height was not different (8.52 ± 2.32 vs. 8.75 ± 1.78 L/m), as was NTproBNP (2,472 [788-5,422] vs. 1,234 [410-6,230] ng/L). On multivariable testing, aPWV was positively associated with β-blocker prescription (standardised β coefficient [Stβ] 0.3, 95% confidence limits [95% CL] 0.7-2.6, p = 0.001) and negatively with icodextrin prescription (Stβ 0.19, 95% CL -0.2 to -2.1, p = 0.04). CONCLUSIONS Compared to previous studies, we did not find an independent association between aPWV and ECW and estimates of ECW excess, using the InBody bioimpedance device, suggesting that vascular stiffness in PD patients is more complex than simple ECW volume expansion in PD patients.
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Affiliation(s)
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital, University College London, London, United Kingdom,
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Zócalo Y, Curcio S, García-Espinosa V, Chiesa P, Giachetto G, Bia D. Comparative Analysis of Arterial Parameters Variations Associated with Inter-Individual Variations in Peripheral and Aortic Blood Pressure: Cross-Sectional Study in Healthy Subjects Aged 2-84 years. High Blood Press Cardiovasc Prev 2017; 24:437-451. [PMID: 28948506 DOI: 10.1007/s40292-017-0231-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 09/12/2017] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The association between arterial parameters and blood pressure (BP) interindividual variations could depend on the arterial segment, BP component (systolic, SBP; diastolic, DBP; pulse pressure, PP) and/or on whether central (cBP) or peripheral (pBP) BP variations are considered. AIM To assess and compare arterial parameters variations associated with interindividual variations in cBP and pBP. METHODS Healthy subjects (n = 923; 488 males, 2-84 years) were included. pBP and cBP waves were obtained (Mobil-O-Graph; SphygmoCor). Arterial diameter, intima-media thickness, local elastic modulus (carotid, CEM; brachial, BEM; femoral, FEM) and regional (carotid-radial and carotid-femoral pulse wave velocity; crPWV and cfPWV) arterial stiffness were determined. Associations between BP and arterial parameters interindividual variations were analyzed and compared (correlations; linear regressions; slopes comparisons) considering data transformed into z-scores. RESULTS Given a variation in z-cSBP or z-pSBP, z-CEM, z-FEM and z-cfPWV (stiffness indexes), were among the parameters with major BP-associated variations. z-crPWV and z-cfPWV, rather than local stiffness indexes were the parameters with major variations associated with z-DBP variations. z-cPP or z-pPP were associated with z-CEM and z-FEM variations, but not with brachial or regional stiffness variations. Most of the arterial parameters-BP slopes did not show significant differences when considering a variation in z-cSBP and z-pSBP. z-CEM and z-FEM were mainly associated with z-cPP and z-pPP variations, respectively. CONCLUSION Disregard of age and sex, the variations in arterial parameters associated with BP interindividual variations showed differences depending on whether variations were central or peripheral; in SBP, DBP or PP and depending on the arterial segment considered.
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Affiliation(s)
- Yanina Zócalo
- Physiology Department, School of Medicine, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Republic University, General Flores 2125, 11800, Montevideo, Uruguay.
| | - Santiago Curcio
- Physiology Department, School of Medicine, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Republic University, General Flores 2125, 11800, Montevideo, Uruguay
| | - Victoria García-Espinosa
- Physiology Department, School of Medicine, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Republic University, General Flores 2125, 11800, Montevideo, Uruguay
| | - Pedro Chiesa
- Servicio de Cardiología Pediátrica, Centro Hospitalario Pereira Rossell, ASSE-Ministry of Public Health, Boulevard Artigas 1550, 11600, Montevideo, Uruguay
| | - Gustavo Giachetto
- Clínica Pediátrica "C", Centro Hospitalario Pereira Rossell, ASSE, Republic University, Boulevard Artigas 1550, 11600, Montevideo, Uruguay
| | - Daniel Bia
- Physiology Department, School of Medicine, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Republic University, General Flores 2125, 11800, Montevideo, Uruguay
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Spronck B, Delhaas T, Butlin M, Reesink KD, Avolio AP. Options for Dealing with Pressure Dependence of Pulse Wave Velocity as a Measure of Arterial Stiffness: An Update of Cardio-Ankle Vascular Index (CAVI) and CAVI0. Pulse (Basel) 2017; 5:106-114. [PMID: 29761084 DOI: 10.1159/000479322] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/06/2017] [Indexed: 12/20/2022] Open
Abstract
Pulse wave velocity (PWV), a marker of arterial stiffness, is known to change instantaneously with changes in blood pressure. In this mini-review, we discuss two main approaches for handling the blood pressure dependence of PWV: (1) converting PWV into a pressure-independent index, and (2) correcting PWV per se for the pressure dependence. Under option 1, we focus on cardio-ankle vascular index (CAVI). CAVI is essentially a form of stiffness index β - CAVI is estimated for a (heart-to-ankle) trajectory, whereas β is estimated for a single artery from pressure and diameter measurements. Stiffness index β, and therefore also CAVI, have been shown to theoretically exhibit a slight residual blood pressure dependence due to the use of diastolic blood pressure instead of a fixed reference blood pressure. Additionally, CAVI exhibits pressure dependence due to the use of an estimated derivative of the pressure-diameter relationship. In this mini-review, we will address CAVI's blood pressure dependence theoretically, but also statistically. Furthermore, we review corrected indices (CAVI0 and β0) that theoretically do not show a residual blood pressure dependence. Under option 2, three ways of correcting PWV are reviewed: (1) using an exponential relationship between pressure and cross-sectional area, (2) by statistical model adjustment, and (3) through reference values or rule of thumb. Method 2 requires a population to be studied to characterise the statistical model, and method 3 requires a representative reference study. Given these limitations, method 1 seems preferable for correcting PWV per se for its blood pressure dependence. In summary, several options are available to handle the blood pressure dependence of PWV. If a blood pressure-independent index is sought, CAVI0 is theoretically preferable over CAVI. If correcting PWV per se is required, using an exponential pressure-area relationship provides the user with a method to correct PWV on an individual basis.
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Affiliation(s)
- Bart Spronck
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.,Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Mark Butlin
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Koen D Reesink
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Alberto P Avolio
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
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Kingue S, Walinjom J, Menanga A, Mintom P, Ngweth MN, Betrand F, Muna W. Arterial compliance in a group of normotensive and untreated hypertensive Cameroonian subjects in Yaounde. Pan Afr Med J 2016; 24:162. [PMID: 27795760 PMCID: PMC5072824 DOI: 10.11604/pamj.2016.24.162.7526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 12/06/2015] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Arterial compliance is an independent predictor of cardiovascular events. It decreases with age and this decrease is accelerated by hypertension. The objectives were to determine the arterial compliance in a group of normotensive and untreated hypertensive stage 1, 2 and 3 Cameroonian subjects. METHODS A cross-sectional study was conducted from August 2012 to February 2013 in Yaoundé. Our sample size was 88 participants. The PulsePen® device was used to determine cfPWV (carotid-femoral Pulse Wave Velocity) and central Augmentation Index % (AIx). Other measurements obtained were: blood pressure (BP), body mass index (BMI), fasting glycaemia, lipid profile and serum creatinine. RESULTS Our sample's mean age was 35.48 years and ranged from 20 to 60 years. The means of: cfPWV, SBP, DBP, Pulse Pressure (PP) and Heart Rate (HR) showed a statistically significant increase (p-value < 0.05) across the groups from normotensive to severely hypertensive patients. cfPWV was significantly correlated (p-value< 0.05) to: Age, Central SBP, Central DBP, Central PP, HR, BMI and central Augmentation index (AIx). Furthermore, cfPWV was significantly dependent on LVH (p-value <0.05). CONCLUSION This study suggests that arterial compliance decreases with increase severity of hypertension, indicating a higher risk of developing cardiovascular events in severely hypertensive patients.
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Affiliation(s)
- Samuel Kingue
- Medical & cardiology Unit, General Hospital Yaoundé, Cameroon
| | - Joshua Walinjom
- Faculty of Medicine and Biomedical sciences, University of Yaoundé I, Cameroon
| | - Alain Menanga
- Medical & cardiology Unit, General Hospital Yaoundé, Cameroon
| | - Pierre Mintom
- Medical & cardiology Unit, General Hospital Yaoundé, Cameroon
| | | | - Fesuh Betrand
- National Advanced School of Engineering, Department of mathematics, Physics and Applied Statistics, University of Yaoundé 1, Cameroon
| | - Walinjom Muna
- Medical & cardiology Unit, General Hospital Yaoundé, Cameroon
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Chmielewski M, Cohen G, Wiecek A, Jesús Carrero J. The peptidic middle molecules: is molecular weight doing the trick? Semin Nephrol 2014; 34:118-34. [PMID: 24780468 DOI: 10.1016/j.semnephrol.2014.02.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Chronic kidney disease (CKD) is characterized by a gradual endogenous intoxication caused by the progressive accumulation of bioactive compounds that in normal conditions would be excreted and/or metabolized by the kidney. Uremic toxicity now is understood as one of the potential causes for the excess of cardiovascular disease and mortality observed in CKD. An important family of uremic toxins is that of the peptidic middle molecules, with a molecular weight ranging between 500 and 60,000 Da, which makes them, as a consequence, difficult to remove in the process of dialysis unless the dialyzer pore size is large enough. This review provides an overview of the main and best-characterized peptidic middle molecules and their role as potential culprits of the cardiometabolic complications inherent to CKD patients.
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Affiliation(s)
- Michal Chmielewski
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Gerald Cohen
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Andrzej Wiecek
- Department of Nephrology, Endocrinology and Metabolic Diseases, Medical University of Silesia, Katowice, Poland
| | - Juan Jesús Carrero
- Division of Nephrology and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.
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Zhu D, Mackenzie NCW, Farquharson C, MacRae VE. Mechanisms and clinical consequences of vascular calcification. Front Endocrinol (Lausanne) 2012; 3:95. [PMID: 22888324 PMCID: PMC3412412 DOI: 10.3389/fendo.2012.00095] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Accepted: 07/17/2012] [Indexed: 12/23/2022] Open
Abstract
Vascular calcification has severe clinical consequences and is considered an accurate predictor of future adverse cardiovascular events, including myocardial infarction and stroke. Previously vascular calcification was thought to be a passive process which involved the deposition of calcium and phosphate in arteries and cardiac valves. However, recent studies have shown that vascular calcification is a highly regulated, cell-mediated process similar to bone formation. In this article, we outline the current understanding of key mechanisms governing vascular calcification and highlight the clinical consequences. By understanding better the molecular pathways and genetic circuitry responsible for the pathological mineralization process novel drug targets may be identified and exploited to combat and reduce the detrimental effects of vascular calcification on human health.
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Affiliation(s)
- Dongxing Zhu
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, The University of EdinburghMidlothian, Scotland, UK
| | - Neil C. W. Mackenzie
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, The University of EdinburghMidlothian, Scotland, UK
| | - Colin Farquharson
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, The University of EdinburghMidlothian, Scotland, UK
| | - Vicky E. MacRae
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, The University of EdinburghMidlothian, Scotland, UK
- *Correspondence: Vicky E. MacRae, The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Roslin, Midlothian EH25 9RG, UK. e-mail:
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Abstract
AbstractElevated pulse wave velocity (PWV) reflects increased arterial stiffness. Several studies have investigated PWV in peritoneal dialysis (PD) patients, but direct comparisons with healthy controls were not done. The potential influence of peritoneal transport characteristics on arterial stiffness in PD patients was suggested in recent studies. The aims of this study were to compare PWV in PD patients and healthy volunteers, and to investigate factors associated with increased PWV. The carotid-femoral PWV was measured in 28 PD patients and 28 healthy controls, matched for age and gender. A peritoneal equilibration test (PET) was performed in all PD patients. Based on the PET, patients were classified as: high transporters (H) (n=8), high-average (HA) (n=12), low-average (LA) (n=6), and low transporters (L) (n=2). Six of the PD patients were diabetic. PWV was significantly higher in the PD patients than in the controls (9,9±2,4 vs. 8,0±0,9; p=0,0004). In the PD group, PWV was higher in H/HA than in L/LA patients (10,4 ± 2,5 vs. 8,6 ± 1,0; p=0,008), but all the diabetic patients were in the H/HA group. PWV was significantly higher in diabetic than in non-diabetic PD patients (12,8 ± 2,0 vs. 9,1 ± 1,7; p=0,004). In the PD patients, significant positive correlations were found between PWV and: age, pulse pressure, Kt/V, and duration of PD therapy. In conclusion, the carotid-femoral PWV is elevated in peritoneal dialysis patients. Increased PWV in PD patients is associated with age, diabetic status, and longer duration of PD therapy, but not with this type of peritoneal transport.
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13
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Plasma interleukin-6 is independently associated with mortality in both hemodialysis and pre-dialysis patients with chronic kidney disease. Kidney Int 2009; 77:550-6. [PMID: 20016471 DOI: 10.1038/ki.2009.503] [Citation(s) in RCA: 207] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Chronic inflammation associated with chronic kidney disease predicts all-cause and cardiovascular mortality in hemodialysis patients. Here we sought to evaluate the association between plasma levels of the inflammatory mediator interleukin-6 (IL-6) and mortality and aortic calcification/stiffness in 125 patients at different stages (2-5D) of chronic kidney disease. Using multivariate linear regression, we found that plasma IL-6 was independently associated with C-reactive protein, albumin and the stage of chronic kidney disease, but not the aortic calcification score or pulse wave velocity. During follow-up studies (median of 829 days), 38 patients died, 22 from cardiovascular events. Plasma IL-6 significantly predicted overall and cardiovascular mortality; this association persisted after multiple adjustments or restricting the analysis to pre-dialysis patients. Moreover, IL-6 was a significantly better predictor of mortality than C-reactive protein, albumin or tumor necrosis factor-alpha. Hence, plasma IL-6 independently predicted overall and cardiovascular mortality in patients at different stages of chronic kidney disease; however, whether lowering plasma IL-6 will affect the outcome of chronic kidney disease will require more direct evaluation.
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Lu Q, Cheng LT, Wang T, Wan J, Liao LL, Zeng J, Qin C, Li KJ. Visceral Fat, Arterial Stiffness, and Endothelial Function in Peritoneal Dialysis Patients. J Ren Nutr 2008; 18:495-502. [DOI: 10.1053/j.jrn.2008.05.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Indexed: 11/11/2022] Open
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15
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Meert N, Schepers E, De Smet R, Argiles A, Cohen G, Deppisch R, Drüeke T, Massy Z, Spasovski G, Stegmayr B, Zidek W, Jankowski J, Vanholder R. Inconsistency of reported uremic toxin concentrations. Artif Organs 2007; 31:600-11. [PMID: 17651115 DOI: 10.1111/j.1525-1594.2007.00434.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Discrepancies in reported uremic toxin concentrations were evaluated for 78 retention solutes. For this analysis, 378 publications were screened. Up to eight publications per toxin were retained. The highest and the lowest reported concentrations, as well as the median reported concentration were registered. The ratio between the highest and the lowest (H/L) concentrations and, for some solutes, also the ratio between the highest and the median (H/M) concentrations were calculated. The compounds were arbitrarily subdivided into three groups based on their H/L ratio: group A, H/L < 3 (n = 33); group B, 3 < H/L < 8.5 (n = 20); and group C, H/L > 8.5 (n = 25). Solutes of groups A and B showed a low to intermediate scatter, suggesting a homogeneity of reported data. Group C showed a more substantial scatter. For at least 10 compounds of group C, extremely divergent concentrations were registered (H/M > 5.5) using scatter plot analysis. For all solutes of groups A and B, the highest reported concentration could be used as a reference. For some solutes of group C and for the compounds showing a divergent scatter analysis, however, more refined directives should be followed.
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Affiliation(s)
- Natalie Meert
- The Nephrology Section, Department of Internal Medicine, University Hospital, Gent, Belgium
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16
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Stancanelli B, Malatino LS, Malaponte G, Noto P, Giuffrè E, Caruso A, Gagliano C, Zoccolo AM, Puccia G, Castellino P. Pulse Pressure Is an Independent Predictor of Aortic Stiffness in Patients with Mild to Moderate Chronic Kidney Disease. Kidney Blood Press Res 2007; 30:283-8. [PMID: 17622773 DOI: 10.1159/000105264] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Accepted: 05/18/2007] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND In patients with end-stage renal disease pulse wave velocity (PWV) has been widely assessed, but its behavior in mild to moderate chronic kidney disease (CKD) has been less investigated. We evaluated PWV in mild to moderate CKD. METHODS We studied 31 patients with grade II-IV CKD. Aortic PWV (aPWV), aortic and upper limb augmentation index, creatinine clearance, C-reactive protein, serum fibrinogen, interleukin-1, interleukin-6, tumor necrosis factor, albumin, total and high-density lipoprotein cholesterol and blood pressure were evaluated. RESULTS aPWV (7.95 +/- 0.64 m/s), but not augmentation index was significantly higher (p = 0.03) in CKD patients than age-matched healthy subjects (aPWV: 6.24 +/- 0.43 m/s; upper limb: 32.8 +/- 1.9; aortic: 27.7 +/- 1.9). At univariate regression analysis, aPWV was significantly correlated with age (r = 0.44; p = 0.013), interleukin-6 (r = 0.43; p = 0.027), pulse (r = 0.39; p = 0.029), systolic blood pressure (r = 0.37; p = 0.038) and tumor necrosis factor (r = 0.39; p = 0.029). At multivariate analysis, pulse pressure was the only significant independent determinant (beta = 0.37; p = 0.05) of aPWV. CONCLUSION The results of this study confirm an aPWV increase in mild to moderate CKD and emphasize association between pulse pressure and PWV, independently of renal failure.
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17
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Stompór T, Rajzer M, Pasowicz M, Kraśniak A, Sułowicz W, Kawecka-Jaszcz K, Tracz W, Janda K, Tabor B, Kowalczyk-Michałek ME, Wójcik K, Konieczyńska M, Klimeczek P, Janusz-Grzybowska E. Coronary artery calcification, common carotid artery intima-media thickness and aortic pulse wave velocity in patients on peritoneal dialysis. Int J Artif Organs 2007; 29:736-44. [PMID: 16969750 DOI: 10.1177/039139880602900802] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
An increasing body of evidence suggests that atherosclerosis in patients with uremia differs from that found in general population in terms of advancement and localization of vascular lesions. It has also been suggested that different non-invasive techniques of vascular system evaluation are designed to show different types of lesions (i.e. vascular calcification, stiffness or 'classical' atherosclerosis). The aim of the study was to search for possible associations between results obtained with three different non-invasive methods of vascular system assessment in three different vascular sites in patients treated with peritoneal dialysis (PD). 61 patients (28 F, 33 M), mean age of 50.4+/-13.6 years, on maintenance PD for a median period of 10 months (range 1-96 months) were included. Coronary artery disease (CAD) was present in 21 subjects. In all subjects coronary artery calcification score (CaSc) using multi-row spiral computed tomography (MSCT), aortic pulse wave velocity (AoPWV) and ultrasound-based common carotid artery intima-media thickness (CCA-IMT) were performed as methods for assessing coronary calcium burden, arterial stiffness and atherosclerosis, respectively. Median value of CaSc equaled 11.5 Agatston units (range 0-5502.8 units). Median AoPWV was 10.4 m/s (range 7.56-18.1 m/s), and median CCA-IMT-0.6 mm (range 0.3-1.0 mm). In 16 patients (26.2%) at least one plaque in at least one common carotid artery was found on ultrasound. CaSc correlated with AoPWV (R=0.32, p<0.01) and with CCA-IMT (R=0.35, p<0.005), whereas no association was found between AoPWV and CCA-IMT. AoPWV, but not CaSc nor IMT correlated with blood pressure. The values of CCA-IMT and AoPWV increased together with consecutive Agatston categories (with p<0.001 for differences in AoPWV and p<0.05 for CCA-IMT). Patients with at least one plaque found in at least one CCA and patients with CAD were characterized with significantly higher values of CaSc, IMT and PWV, when compared to plaque-free and CAD- negative subjects, respectively. Association between CaSc and both IMT and PWV may suggest that the mechanism of three assessed vascular pathologies may be based, to some extent, on the process of pathologic calcium-phosphate deposition. Lack of correlation found between PWV and IMT may suggest that aortic stiffness and carotid atherosclerosis may partially differ in their pathologic background and/or are dissociated in time.
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Affiliation(s)
- T Stompór
- Department of Nephrology, Jagiellonian University, Cracow, Poland.
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18
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Kim EJ, Park CG, Park JS, Suh SY, Choi CU, Kim JW, Kim SH, Lim HE, Rha SW, Seo HS, Oh DJ. Relationship between blood pressure parameters and pulse wave velocity in normotensive and hypertensive subjects: invasive study. J Hum Hypertens 2006; 21:141-8. [PMID: 17136108 DOI: 10.1038/sj.jhh.1002120] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Blood pressure (BP) is one of the most important contributing factors to pulse wave velocity (PWV), a classic measure of arterial stiffness. Although there have been many non-invasive studies to show the relation between arterial stiffness and BP, the results are controversial. The aim of this study is to evaluate the role of BP as an influencing factor on PWV using invasive method. We observed 174 normotensive and untreated hypertensive subjects using coronary angiography. Arterial stiffness was assessed through aorto-femoral PWV by foot-to-foot velocity method using fluid-filled system. And BP was measured by pressure wave at the right common femoral artery. From univariate analysis, age, diabetes mellitus (DM), hypertension, waist, waist-to-hip ratio, total cholesterol-to-high-density lipoprotein cholesterol ratio, systolic BP (SBP), pulse pressure (PP) and mean arterial pressure (MAP) showed significant association with PWV. To avoid multiple colinearity among SBP, PP and MAP, we performed multiple regression analysis predicting PWV thrice. Age, DM and each BP were significantly and consistently correlated to PWV. In the first and third modules, compared to age, SBP and MAP were less strong predictors, respectively. However, PP was the stronger predictor than age and DM in the second module. Lastly, we simultaneously forced MAP and PP with other variables in the fourth multivariate analysis. Age, DM and PP remained significantly correlated with PWV, but the significance of MAP was lost. This is the first invasive study to suggest that PP has the strongest correlation with PWV among a variety of BP parameters.
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Affiliation(s)
- E J Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Guro-gu, Seoul, Republic of Korea
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Lee JA, Kim DH, Yu SJ, Oh DJ, Yu SH. Association of serum albumin and homocysteine levels and cardio-ankle vascular index in patients with continuous ambulatory peritoneal dialysis. Korean J Intern Med 2006; 21:33-8. [PMID: 16646562 PMCID: PMC3891061 DOI: 10.3904/kjim.2006.21.1.33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2005] [Accepted: 11/27/2005] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The cardio-ankle vascular index (CAVI) is a newly developed arteriosclerotic measurement that has been proposed as an alternative to aortic pulse-wave velocity (PWV). The present study used the CAVI to identify the main factors associated with arteriosclerosis in continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS Fifteen CAPD patients were enrolled in the study. The CAVI is independent of the pressure and vascular reflection between the heart valve and the ankle. Serum albumin, uric acid, total calcium, phosphorus, lipid levels, high-sensitivity C-reactive protein and homocysteine concentrations in CAPD patients were measured using standard methods. Total body fat mass, truncal and non-truncal fat mass and lean body mass were measured using dual energy X-ray absorptiometry with a Lunar DPX-L scanner. RESULTS CAPD patients had a mean CAVI of 9.37 +/- 3.16 m/sec, which was higher than the general population. The CAVI was negatively correlated with the serum albumin concentration (r=-0.548; p=0.034). Stepwise regression analysis showed that both the serum albumin concentration (beta=-0.643, p=0.013) and the serum homocysteine level (beta=0.486, p=0.004) were independently associated with the CAVI. CONCLUSIONS An increase in CAVI was independently associated with both serum albumin and homocysteine level.
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Affiliation(s)
- Jung-Ahn Lee
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Do-Hyung Kim
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Soo-Jeong Yu
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Dong-Jin Oh
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Suk-Hee Yu
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Korea
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Abstract
According to recent data, arterial stiffness is a major independent risk factor for cardiovascular morbidity and mortality in both the general and renal populations. Because of several factors (vascular calcifications among them), large arteries are stiffer in patients with chronic kidney disease compared with the nonrenal population, contributing to the enormous cardiovascular mortality in renal patients. This review briefly analyzes methods for determination of arterial stiffness, focusing on 2 parameters, pulse wave velocity and the augmentation index, particularly useful in assessing arterial compliance in renal patients. Effects of different methods of renal replacement therapy on arterial wall properties also are discussed. Finally, the most promising novel and/or potential therapies regarding reduction of arterial stiffness in renal patients are reviewed.
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Affiliation(s)
- Adrian Covic
- Dialysis and Renal Transplantation Center, Parhon University Hospital, Iasi, Romania.
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22
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Axelsson J, Rashid Qureshi A, Suliman ME, Honda H, Pecoits-Filho R, Heimbürger O, Lindholm B, Cederholm T, Stenvinkel P. Truncal fat mass as a contributor to inflammation in end-stage renal disease. Am J Clin Nutr 2004; 80:1222-9. [PMID: 15531669 DOI: 10.1093/ajcn/80.5.1222] [Citation(s) in RCA: 150] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND An activated inflammatory response is a common feature of end-stage renal disease (ESRD) and predicts outcome. Adipose tissue is an endocrine organ that may contribute to an inflammatory burden by secreting adipocytokines such as interleukin 6 (IL-6). OBJECTIVE The objective was to relate plasma concentrations of IL-6 in ESRD patients to body composition, regional fat mass distribution, and blood lipid profiles. DESIGN One hundred ninety-seven ESRD patients (123 men; +/- SE age: 52 +/- 1 y) were evaluated shortly before dialysis started. Lean body mass and truncal and nontruncal fat mass were estimated by dual-energy X-ray absorptiometry. Nutritional status was evaluated on the basis of subjective global assessment and handgrip strength. Inflammatory biomarker and blood lipid concentrations were also evaluated. RESULTS Median IL-6 (8.5 compared with 4.5 pg/mL; P < 0.001) concentrations were significantly greater in malnourished than in well-nourished patients. Moreover, negative correlations were observed between IL-6 and serum creatinine (rho = -0.19, P < 0.01), handgrip strength (rho = -0.24, P < 0.001), and serum albumin (rho = -0.34, P < 0.001). A significantly higher truncal fat mass (12.8 +/- 0.7 compared with 10.5 +/- 0.4 kg; P < 0.005) was observed in ESRD patients with inflammation (C-reactive protein >/= 10 mg/L). Inverse correlations were observed between plasma IL-6 and HDL cholesterol (rho = -0.16, P < 0.05) and apolipoprotein A (rho = -0.23, P < 0.001). CONCLUSIONS Plausible relations exist between inflammatory biomarkers, such as IL-6 and high-sensitivity C-reactive protein, and regional fat distribution in ESRD patients. Moreover, the strong inverse relations between HDL cholesterol and apolipoprotein A and biomarkers of inflammation suggest that the chronic inflammatory response observed in ESRD patients is an important contributor to the atherogenic lipoprotein profile in uremia.
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Affiliation(s)
- Jonas Axelsson
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Karolinska Institutet, Karolinska University Hospital, Stockholm
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La velocidad de onda de pulso, el QKd y la monitorización ambulatoria de presión arterial como indicadores de riesgo vascular en un grupo de pacientes sometidos a diálisis peritoneal continua ambulatoria. HIPERTENSION Y RIESGO VASCULAR 2004. [DOI: 10.1016/s1889-1837(04)71445-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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