Assessment of vascular function in patients with chronic kidney disease

Area of Science:

• Nephrology
• Cardiology
• Vascular Biology

Background:

• Patients with chronic kidney disease (CKD) face a higher risk of cardiovascular disease (CVD) than the general population.
• Traditional CVD risk factors only partially explain this increased risk.
• Vascular dysfunction, encompassing endothelial dysfunction and arterial stiffness, is a key non-traditional risk factor in CKD.

Purpose of the Study:

• To discuss methods for assessing vascular dysfunction in CKD patients.
• To highlight the role of impaired endothelium-dependent dilation (EDD) and arterial stiffness in CKD-related CVD risk.
• To explore the contribution of oxidative stress and reduced nitric oxide (NO) bioavailability to vascular dysfunction in CKD.

Main Methods:

• Assessing brachial artery flow-mediated dilation (FMDBA) to measure EDD.
• Measuring aortic pulse-wave velocity (aPWV) to assess large elastic artery stiffness.
• Analyzing vascular endothelial cell protein expression for oxidative stress markers via immunofluorescence.

Main Results:

• Patients with CKD demonstrate impaired FMDBA and increased aPWV.
• Both FMDBA and aPWV are independent predictors of cardiovascular events in CKD and non-CKD populations.
• Increased oxidative stress and reduced NO bioavailability are significant contributors to vascular dysfunction in CKD.

Conclusions:

• Vascular dysfunction is prevalent in CKD and contributes to CVD risk.
• Noninvasive measures like FMDBA and aPWV are valuable for risk assessment in CKD.
• Understanding cellular mechanisms, such as oxidative stress, is crucial for managing vascular complications in CKD.