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Assessment of Vascular Function in Patients With Chronic Kidney Disease
08:50

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Published on: June 16, 2014

Arterial remodeling associates with CKD progression.

Marie Briet1, Cédric Collin, Alexandre Karras

  • 1Department of Pharmacology and Institut National de la Santé et de la Recherche Médicale U970-PARCC, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, 20, rue Leblanc, 75015 Paris, France; mariebriet1@free.fr

Journal of the American Society of Nephrology : JASN
|April 16, 2011
PubMed
Summary

Arterial remodeling in chronic kidney disease (CKD) accelerates kidney function decline. Maladaptive carotid artery changes and increased pulse pressure independently predict faster GFR loss and end-stage renal disease (ESRD) in CKD patients.

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Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Vascular Biology

Background:

  • Chronic kidney disease (CKD) is associated with arterial stiffening and remodeling.
  • Increased pulsatile pressure due to arterial stiffness may contribute to renal damage and CKD progression.

Purpose of the Study:

  • To investigate the relationship between large artery remodeling, stiffness, and CKD progression.
  • To determine if carotid artery changes predict GFR decline and risk of end-stage renal disease (ESRD).

Main Methods:

  • Prospective study of 180 CKD patients (mean GFR 32 ml/min/1.73 m(2)) followed for 3.1 years.
  • Measurements included carotid-femoral pulse wave velocity, aortic pressure, carotid remodeling (intima-media thickness, diameter), and stiffness.
  • Statistical analysis used linear mixed models and multivariable Cox models.

Main Results:

  • Carotid stiffness significantly increased during follow-up, while aortic stiffness did not.
  • Carotid artery remodeling led to increased circumferential wall stress.
  • Increased carotid circumferential wall stress was associated with faster GFR decline.
  • Carotid circumferential wall stress and pulse pressure independently predicted higher risk for ESRD.
  • Arterial stiffness parameters did not associate with CKD progression.

Conclusions:

  • Maladaptive remodeling of the carotid artery, characterized by increased circumferential wall stress, is linked to faster GFR decline in CKD.
  • Increased pulse pressure and carotid artery wall stress are independent predictors of progression to ESRD.
  • These vascular changes, rather than arterial stiffness alone, may be key drivers of CKD progression.