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Updated: May 22, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Impaired global myocardial flow dynamics despite normal left ventricular function and regional perfusion in chronic
Kenji Fukushima1, Mehrbod S Javadi, Takahiro Higuchi
1Division of Nuclear Medicine, Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA.
Insights
Chronic kidney disease (CKD) impairs myocardial flow reserve (MFR) primarily due to increased resting blood flow, not reduced stress flow. This microvascular dysfunction is linked to reduced kidney function.
Area of Science:
- Cardiology
- Nephrology
- Nuclear Medicine
Background:
- Impaired myocardial flow reserve (MFR) is linked to cardiac events and coronary artery disease (CAD).
- Chronic kidney disease (CKD) is an independent risk factor for cardiovascular disease.
- The impact of CKD on myocardial microcirculation in patients without obstructive CAD is not well understood.
Purpose of the Study:
- To investigate the effect of CKD on myocardial microcirculation.
- To assess myocardial blood flow (MBF) and MFR in CKD patients with normal left ventricular (LV) function and no flow-limiting CAD.
Main Methods:
- Utilized Rubidium-82 (82Rb) PET/CT in 40 CKD patients and 42 matched controls.
- Quantified MBF and MFR using a validated retention model.
- Excluded patients with hemodialysis, renal transplant, abnormal perfusion, or reduced LV function.
Main Results:
- CKD patients had significantly reduced MFR (2.2 ± 1.0 vs. 3.0 ± 1.2, P = 0.027).
- Elevated resting MBF (1.1 ± 0.4 vs. 0.8 ± 0.2 mL/min/g, P = 0.007) was the primary driver of reduced MFR in CKD.
- MFR significantly correlated with estimated glomerular filtration rate (eGFR) (r = 0.41; P = 0.0005).
Conclusions:
- MFR is impaired in CKD patients with preserved LV function and normal regional perfusion.
- Elevated resting MBF, not reduced stress MBF, underlies MFR impairment in CKD.
- Absolute MBF quantification may identify microvascular dysfunction as a precursor to CAD in CKD patients.
Unlabelled:
Impaired global myocardial flow reserve (MFR) may be associated with increased risk for cardiac events and coronary artery disease progression. Chronic kidney disease (CKD) is also considered a risk factor for cardiovascular disease. We sought to investigate the effect of CKD on the myocardial microcirculation in patients referred for clinical (82)Rb PET/CT, who had normal left ventricular (LV) function and no flow-limiting coronary artery disease.
Methods:
Estimated glomerular filtration rate (eGFR) was available for 230 patients who had undergone rest and pharmacologic stress (82)Rb PET/CT for suspected coronary artery disease. CKD was defined as an eGFR less than 60 mL/min/1.73 m(2). After patients with hemodialysis, a renal transplant, abnormal regional perfusion (summed stress score > 4), or reduced LV function (LV ejection fraction < 45%) were excluded, 40 CKD patients remained. Those were compared with a control group without CKD, which was matched for age, sex, coronary risk factors, and systemic hemodynamics (n = 42). List-mode acquisition of PET enabled quantification of myocardial blood flow (MBF) and MFR using a previously validated retention model with correction for (82)Rb extraction. Rest MBF was normalized to rate-pressure product.
Results:
Mean eGFR in the CKD group was reduced (44 ± 14 vs. 99 ± 28 mL/min/1.73 m(2); P < 0.0001), and creatinine was significantly elevated, compared with controls (1.9 ± 1.1 vs. 0.8 ± 0.2 mg/dL; P < 0.0001). MFR was significantly reduced in CKD (2.2 ± 1.0 vs. 3.0 ± 1.2 for controls; P = 0.027). This reduction was mainly due to increased rest MBF (1.1 ± 0.4 in CKD vs. 0.8 ± 0.2 mL/min/g in controls; P = 0.007). Stress myocardial flow was comparable between both groups (2.3 ± 0.9 vs. 2.3 ± 0.8 mL/min/g; P = 0.08). Overall, MFR was significantly correlated with eGFR (r = 0.41; P = 0.0005). Stress MBF did not correlate with eGFR (r = 0.002; P = 0.45), but rest MBF showed an inverse correlation (r = -0.49; P < 0.0001). Rest MBF was also inversely correlated with hemoglobin (r = -0.28; P = 0.014), but only eGFR was an independent correlate at multivariate analysis.
Conclusion:
MFR is impaired in patients with renal insufficiency with normal regional perfusion and LV function, mostly because of elevated rest flow. Absolute quantification of flow may be useful to identify microvascular dysfunction as a precursor of clinically overt coronary disease in this specific risk group.
