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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Markers of increased atherosclerotic risk in patients with chronic kidney disease: a preliminary study
Anna Gluba-Brzózka1,2, Marta Michalska-Kasiczak3, Beata Franczyk4
1Department of Nephrology, Hypertension and Family Medicine, WAM University Hospital of Lodz, Poland, Żeromskiego 113, 90-549, Łódź, Poland. aniagluba@yahoo.pl.
Insights
Chronic kidney disease (CKD) patients exhibit high rates of ventricular hypertrophy and diastolic dysfunction. Increased MMP-2 and MMP-2/TIMP-2, with lower TIMP-1, suggest their role in atherosclerosis development in CKD.
Area of Science:
- Nephrology
- Cardiology
- Biochemistry
Background:
- Chronic kidney disease (CKD) prevalence is increasing globally.
- Cardiovascular disease (CVD) is a major cause of mortality in CKD patients.
- Early CKD stages are linked to elevated coronary heart disease risk.
Purpose of the Study:
- To identify atherosclerosis risk markers in CKD patients.
- To investigate the association between specific proteins and atherosclerosis in CKD.
- To evaluate cardiac structural and functional changes in different CKD stages.
Main Methods:
- Studied 80 CKD patients across stages I-V/dialysis and 24 healthy controls.
- Measured protein levels (osteoprotegerin, osteopontin, osteocalcin, MGP, fetuin A, MMP-2, MMP-9, TIMP-1, TIMP-2) and biochemical parameters.
- Performed cardiac echocardiography to assess cardiac structure, function, hypertrophy, and valve calcification.
Main Results:
- High prevalence of ventricular hypertrophy (95.3%) and diastolic dysfunction (93.2%) in CKD patients.
- Significantly higher E/E' ratio, tricuspid insufficiency, contractile dysfunction, mitral valve calcification, and aortic valve calcification in stage V/dialysis CKD patients.
- MMP-2, MMP-2/TIMP-2 ratio, and TIMP-1 levels differed significantly between CKD groups.
Conclusions:
- CKD is associated with a high incidence of ventricular hypertrophy and diastolic dysfunction.
- Contractile dysfunction and valve calcification are more prevalent in hemodialysis patients.
- Elevated MMP-2, MMP-2/TIMP-2 ratio, and reduced TIMP-1 may contribute to atherosclerosis pathogenesis in CKD.
Background:
The prevalence of chronic kidney disease is rising continuously. Cardiovascular disease is among leading causes of death and premature mortality of patients with chronic kidney disease. Even the earliest stages of chronic kidney disease are associated with higher risk of subsequent coronary heart disease. The aim of this study was to determine markers of increased risk of atherosclerosis in CKD.
Methods:
The study group consisted of a total of 80 patients (20 patients with stage I/II CKD, 20 with stage III CKD, 20 stage IV CKD and 20 stage V/dialysis) and 24 healthy volunteers. Levels of proteins (osteoprotegerin, osteopontin, osteocalcin, matrix γ-carboxyglutamic acid protein, fetuin A, MMP-2, MMP-9, TIMP-1, TIMP-2) and biochemical parameters were measured to analyse their influence on atherosclerosis risk in CKD patients. Cardiac echocardiography was performed to assess structural integrity and function, presence of left ventricular hypertrophy and systolic and diastolic function dysfunction.
Results:
This study shows that the prevalence of ventricular hypertrophy (95.3 %) and diastolic dysfunction (93.2 %) in CKD patients is high. Also E/E' ratio was significantly higher (13.6 ± 4.4, p = 0.001), tricuspid insufficiency (27.3 in CKD I/II vs. 71.4 in CKD V, p = 0.016), contractile dysfunction (33.3 in CKD I/II vs. 78.9 in CKD V, p = 0.040), mitral valve calcification (0 in CKD I/II vs. 28.6 in CKD V, p = 0.044) and aortic valve calcification (0 in CKD I/II vs. 61.9 in CKD V, p = 0.0008) were significantly more frequent in patients with CKD stage V/dialysis than in other groups. Only MMP-2, MMP-2/TIMP-2 ratio and TIMP-1 differed significantly between groups.
Conclusions:
This study shows high prevalence of ventricular hypertrophy and diastolic dysfunction in CKD patients. Contractile dysfunction, mitral and aortic valve calcification in HD patients were significantly more frequent than in patients with other CKD stages. Significantly increased levels of MMP-2, MMP-2/TIMP-2 ratio and lower TIMP-1 suggests that these factors may be involved in the pathogenesis of atherosclerosis in CKD patients.
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