Arterial stiffness &Sri Lankan chronic kidney disease of unknown origin

Area of Science:

• Nephrology
• Cardiology
• Public Health

Background:

• Chronic kidney disease (CKD) is a significant risk factor for cardiovascular disease (CVD).
• Arterial stiffness is a key contributor to CVD risk in CKD patients.
• A substantial portion of CKD in developing nations, like Sri Lanka, remains unexplained (CKDu).

Purpose of the Study:

• To compare arterial stiffness in Sri Lankan CKDu patients versus those with defined CKD and healthy controls.
• To investigate the relationship between CKDu, arterial stiffness, and cardiovascular risk factors.

Main Methods:

• A cross-sectional study involving 130 participants: 50 with CKDu, 45 with CKD, and 35 controls.
• Assessment of aortic blood pressure (BP), pulse wave velocity (PWV), and augmentation index (AIx) using the TensioMed™ Arteriograph.
• Statistical analysis to compare arterial stiffness parameters across the three groups, with and without adjustment for diabetes.

Main Results:

• Subjects with CKDu and CKD had higher BP than controls, with no significant difference between CKDu and CKD groups.
• Controls exhibited lower PWV compared to both CKDu and CKD groups.
• Crucially, CKDu subjects demonstrated significantly lower PWV than CKD subjects, even with equivalent BP and renal dysfunction (8.7 vs. 9.9 m/s).
• Excluding diabetes further highlighted these differences, with PWV values for controls, CKDu, and CKD being 6.7, 8.7, and 10.4 m/s, respectively (p < 0.001).

Conclusions:

• Sri Lankan CKDu is associated with reduced arterial stiffness compared to defined CKD.
• The findings suggest that CKDu may have a different pathophysiological profile regarding vascular health.
• Long-term cardiovascular morbidity and mortality implications require further investigation in CKDu populations.