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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Aortic distensibility and arterial-ventricular coupling in early chronic kidney disease: a pattern resembling heart
N C Edwards1, C J Ferro, J N Townend
1Department of Cardiology, University of Birmingham and University Hospital Birmingham, Birmingham, UK.
Insights
Early-stage chronic kidney disease (CKD) leads to stiffer arteries and impaired heart function, increasing cardiovascular risk. This arterial-ventricular stiffness pattern resembles heart failure with preserved ejection fraction.
Area of Science:
- Cardiovascular Physiology
- Nephrology
- Biomedical Engineering
Background:
- Early-stage chronic kidney disease (CKD) is associated with increased cardiovascular risk.
- Understanding arterial and ventricular function in early CKD is crucial for risk stratification and management.
- This study investigates the interplay between arterial and left ventricular function in non-diabetic CKD patients.
Purpose of the Study:
- To examine arterial and left ventricular function in patients with early-stage CKD.
- To assess the interaction between arterial stiffness and ventricular elastance.
- To compare cardiovascular parameters in early CKD patients with healthy controls.
Main Methods:
- Cross-sectional observational study involving 117 patients with stage 2 or 3 non-diabetic CKD and 40 controls.
- Cardiac magnetic resonance imaging (CMR) used to assess aortic distensibility and left ventricular mass.
- Transthoracic echocardiography employed to evaluate systolic and diastolic ventricular function and arterial-ventricular elastance.
Main Results:
- Patients with early CKD exhibited reduced aortic distensibility and increased arterial elastance compared to controls.
- Left ventricular end-systolic and end-diastolic elastances were significantly increased in CKD patients.
- While systolic function remained unimpaired, diastolic filling velocities were reduced, and mean left atrial pressure was elevated in early CKD.
Conclusions:
- Early-stage CKD is characterized by arterial stiffening and increased ventricular stiffness.
- The observed pattern of arterial and ventricular dysfunction resembles that seen in heart failure with preserved ejection fraction.
- These pathophysiological changes may contribute to the high cardiovascular morbidity and mortality observed across all stages of CKD.
Objectives:
To examine arterial and left ventricular function and their interaction in patients with early-stage chronic kidney disease (CKD).
Design And Setting:
Cross-sectional observational study in a university teaching hospital.
Patients:
117 patients with stage 2 (60-89 ml/min/1.73 m(2)) or stage 3 (30-59 ml/min/1.73 m(2)) non-diabetic CKD, without overt cardiovascular disease were compared with 40 controls.
Interventions:
Aortic distensibility and left ventricular mass were assessed using cardiac magnetic resonance imaging. Systolic and diastolic ventricular function and arterial-ventricular elastance (stiffness) were assessed by transthoracic echocardiography.
Main Outcome Measures:
Arterial stiffness as measured by aortic distensibility and arterial elastance. Left ventricular mass, left ventricular systolic and diastolic function, including end-diastolic and end-systolic elastance and their relationship with arterial elastance.
Results:
Compared with controls, patients with CKD 2 and CKD 3 had reduced aortic distensibility (4.12 (1.3) vs 2.94 (1.8) vs 2.18 (1.8)x10(-3) mm Hg, p<0.01), increased arterial elastance (1.4 (1.3) vs 1.65 (0.40) vs 1.74 0.48) mm Hg, p<0.05) and increased end-systolic (1.88 (0.48) vs 2.43 (0.83) vs 2.42(0.78) mm Hg/ml, p<0.05) and end diastolic elastances (0.07 (0.04) vs 0.11 (0.04) vs 0.12 (0.04, p<0.01). Aortic distensibility was positively correlated with estimated glomerular filtration rate (r = 0.349, p<0.01) and indices of elastance were inversely correlated (r = 0.284, p<0.05). Systolic function was not impaired in patients with early CKD compared with controls but diastolic filling velocities (Em) were reduced (8.1 (0.9) vs 7.9 (0.6) vs 7.5 (0.7) cm/s, p<0.01) while mean left atrial pressure (E/Em) was increased (5.6 (1.1), vs 7.4 (1.8) vs 8.0 (2.4), p<0.01) and end-diastolic elastance was increased.
Conclusions:
Early-stage CKD is characterised by reduced aortic distensibility and increases in arterial, ventricular systolic and diastolic stiffness; arterial-ventricular coupling is preserved. This pattern of pathophysiological abnormalities resembles that seen in heart failure with preserved ejection fraction and may account for the high levels of cardiovascular morbidity and mortality in patients at all stages of CKD.
Trial Registration Number:
NCT00291720.
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