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Coronary flow velocity reserve and inflammatory markers in living kidney donors
Ashwin Radhakrishnan1, Anna M Price2, Luke C Pickup1
1Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom.
Insights
Living kidney donors show reduced coronary flow velocity reserve (CFVR), indicating microvascular dysfunction. This suggests that even mild kidney function decline may impact heart health, potentially linked to inflammation.
Area of Science:
- Cardiology
- Nephrology
- Vascular Biology
Background:
- Coronary microvascular dysfunction is common in chronic kidney disease (CKD).
- Coronary flow velocity reserve (CFVR) measures microvascular function and decreases with CKD stage.
- Living kidney donors have early-stage CKD-like renal function, raising cardiovascular risk concerns.
Purpose of the Study:
- To investigate coronary microvascular function in living kidney donors.
- To assess if reduced renal function in donors is associated with coronary microvascular dysfunction.
Main Methods:
- 23 living kidney donors and 25 healthy controls were studied.
- Transthoracic echocardiography and Doppler CFVR were used.
- Myocardial contrast echocardiography and serum biomarker analysis were performed.
Main Results:
- Living kidney donors had significantly lower Doppler CFVR than controls (3.4 vs 3.8, p=.036).
- A trend towards reduced coronary flow reserve was observed via myocardial contrast echocardiography.
- Donors showed higher hsCRP and lower uromodulin levels.
Conclusions:
- This is the first study to report CFVR in living kidney donors.
- Reduced renal function in donors is associated with impaired coronary microvascular function.
- Subclinical inflammation, indicated by hsCRP and uromodulin changes, may underlie this dysfunction.
Background:
Coronary microvascular dysfunction is prevalent in chronic kidney disease (CKD), and may contribute to the development of myocardial dysfunction in CKD. Coronary flow velocity reserve (CFVR) is a marker of coronary microvascular function and falls with increasing CKD stage. Living kidney donors have renal function consistent with early stage CKD and concern has been raised about their cardiovascular risk. No studies to date have investigated the presence of coronary microvascular dysfunction in living kidney donors.
Methods:
25 healthy controls and 23 living kidney donors were recruited and underwent assessment with transthoracic echocardiography, Doppler CFVR, myocardial contrast echocardiography and serum multiplex immunoassay panels.
Results:
Doppler CFVR was significantly reduced in living kidney donors compared to controls (mean CFVR 3.4 ± 0.7 vs 3.8 ± 0.6, mean difference 0.4 95% confidence interval 0.03-0.8, p =.036). Quantitative myocardial contrast echocardiography showed a trend towards reduced coronary flow reserve in living kidney donors. Compared to controls, living kidney donors had higher serum high sensitivity C reactive peptide (hsCRP) and lower levels of uromodulin.
Conclusions:
This is the first study of CFVR in living kidney donors. We have shown that the modest drop in estimated glomerular filtration rate in living kidney donors is associated with lower values of Doppler CFVR compared to controls, suggesting that isolated reductions in renal function may lead to altered microvascular function. The increase in hsCRP and reduction in uromodulin suggests that chronic subclinical inflammation may contribute to altered microvascular function in this population.
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