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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
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Mediation analysis of aortic stiffness and renal microvascular function
Todd Woodard1, Sigurdur Sigurdsson2, John D Gotal1
1Cardiovascular Engineering Inc., Norwood, Massachusetts;
Journal of the American Society of Nephrology : JASN
|October 9, 2014
Summary
Aortic stiffness, a measure of blood vessel hardening, contributes to reduced kidney function (GFR) by increasing blood flow pulsatility to the kidneys. This pulsatility damages the renal microvasculature, leading to decreased GFR.
Area of Science:
- Cardiovascular Physiology
- Nephrology
- Aging Research
Background:
- Aortic stiffening is linked to chronic kidney disease (CKD).
- Excessive flow pulsatility transmission to renal microvasculature may explain this link.
- Direct analysis of macrovascular-microvascular relationships in the kidney is limited.
Purpose of the Study:
- To investigate the relationship between aortic stiffness, kidney function (GFR), and urinary albumin excretion.
- To explore potential mediators, including renal artery pulsatility index, renal vascular resistance, and cortical arterial volume.
- To provide evidence for the mechanism linking aortic stiffness to reduced GFR.
Main Methods:
- Carotid-femoral pulse wave velocity measured arterial stiffness.
- Iohexol clearance assessed glomerular filtration rate (GFR).
- Magnetic resonance imaging and arterial tonometry evaluated renal hemodynamics and microvasculature in 367 older adults.
Main Results:
- Aortic stiffness was significantly associated with lower GFR (B=-2.28±0.85 ml/min per SD, P=0.008).
- The association between aortic stiffness and GFR was attenuated after accounting for renal artery pulsatility index (P=0.10).
- Mediation analysis indicated pulsatility index (34%), cortical arterial volume (20%), and renal vascular resistance (36%) mediated the relationship.
Conclusions:
- Aortic stiffness contributes to reduced GFR by increasing pulsatility in the renal microvasculature.
- This increased pulsatility may cause dynamic constriction or loss of renal microvessels.
- Findings offer the first evidence of aortic stiffness impacting GFR via renal microvascular mechanisms.
