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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Carotid artery diameter and wall stiffness in proteinuric renal disease without severely reduced kidney function
MariaRosaria Iannuzzi1, Antonio D'Angelillo1, Antonia Tortori2
1Nephrology and Dialysis Unit, Antonio Cardarelli Hospital, Naples, Via A. Cardarelli 9, 80131, Naples, Italy.
Insights
Patients with glomerulopathy and proteinuria show thicker carotid artery walls and increased stiffness, even with preserved kidney function. This indicates early arterial changes in kidney disease patients.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Vascular Biology
Background:
- Glomerulopathy and proteinuria are associated with increased cardiovascular risk.
- Early detection of vascular changes is crucial for managing patients with kidney disease.
Purpose of the Study:
- To assess carotid artery structure and elasticity in patients with glomerulopathy and proteinuria.
- To investigate arterial wall properties in individuals with preserved kidney function (glomerular filtration rate > 30 ml/min/1.73 m²).
Main Methods:
- A comparative study involving 30 patients with various glomerular diseases and 30 healthy controls.
- Carotid artery intima-media thickness, diameter, and stiffness were measured using laboratory evaluations.
- Statistical analysis was performed, adjusting for age, sex, and metabolic cardiovascular risk factors.
Main Results:
- Patients exhibited significantly thicker carotid intima-media complex area compared to controls (18.6 vs. 14.8 mm², p=0.014).
- Carotid artery wall stiffness was markedly higher in patients (8.96 vs. 5.65, p<0.01).
- These differences remained statistically significant after adjusting for cardiovascular risk factors (adjusted p<0.001).
Conclusions:
- This study reveals, for the first time, altered structural and elastic properties of the carotid artery in patients with proteinuria and glomerular disease.
- These findings suggest subclinical vascular damage occurs early in the course of kidney disease, even before significant kidney function decline.
- The results highlight the importance of monitoring cardiovascular health in patients with glomerulopathy and proteinuria.
Purpose:
To evaluate the carotid artery diameter, and wall thickness and stiffness in patients with glomerulopathy and proteinuria without severely reduced kidney function.
Methods:
We compared 30 control subjects to 30 patients with glomerular disease, proteinuria, and glomerular filtration rate > 30 ml/min/1.73 m(2) : membranous glomerulonephritis (n = 13), minimal change disease (n = 2), focal and segmental glomerulosclerosis (n = 3), IgA nephropathy (n = 5), lupus nephritis (n = 5), antiphospholipid antibody nephropathy (n = 1), cryoglobulinemic glomerulonephritis (n = 1). The laboratory evaluations included carotid artery diameter, intima-media thickness, and stiffness measurements.
Results:
Carotid cross-sectional area of intima-media complex was thicker in patients (18.6 ± 1.4 [x ± SEM]) than in controls (14.8 ± 0.6 mm(2) , p = 0.014), as was carotid artery wall stiffness (8.96 ± 0.86 versus 5.65 ± 0.38, [x ± SEM], p < 0.01). This difference remained significant after adjustment for age, sex, and metabolic cardiovascular risk factors: carotid stiffness was 9.19 ± 0.67 (99% confidence interval [CI] 7.40-10.98)] in patients and 4.80 ± 0.75 (99% CI 2.79-7.11) in controls; adjusted mean difference 4.40 (99% CI 1.46-7.34); p <0.001.
Conclusions:
This study showed, for the first time, signs of altered structural and elastic properties of the arterial wall in patients with proteinuria and glomerular disease without severely reduced kidney function.
