Vascular calcifications, arterial aging and arterial remodeling in ESRD

Accelerated arterial aging and inadequate outward arterial remodeling are observed in end-stage renal disease (ESRD) patients. Whether these changes could be closely associated with arterial calcifications has never been investigated.

155 ESRD patients and 105 age-, sex-, and blood pressure-matched control subjects were included. Common carotid artery (CCA) pressure, diameter, intima-media thickness, elastic modulus, and presence of calcified plaques were measured ultrasonographically. Carotid artery stiffness was determined from simultaneously recorded CCA diameter and stroke changes in diameter and CCA pressure waveforms, obtained by applanation tonometry.

Compared with control subjects, ESRD patients had increased CCA systolic and pulse pressures (p < 0.001), larger CCA diameter (p < 0.001) and CCA intima-media thickness (p < 0.01) and similar CCA relative wall thickness. In ESRD patients the arterial remodeling was associated with increased CCA elastic modulus/stiffness (p < 0.001). In ESRD patients the association between CCA elastic modulus and age was characterized by a steeper slope (p = 0.03), but after separation of uremic patients according to the presence of calcifications, the accelerated aging was observed only in calcified subjects. Despite higher CCA systolic and pulse pressures, the CCA relative wall thickness was similar to controls indicating an inadequate pressure-associated remodeling. Moreover, the positive systolic pressure/relative thickness correlation observed in control subjects was lost with paradoxical negative correlation in calcified ESRD patients (p = 0.03).

These results indicate that, in ESRD patients, accelerated arterial aging and inadequate arterial hypertrophy are closely associated with the calcifications of arterial walls. Inadequate hypertrophy is responsible for high circumferential stress applied on the vessels.