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Updated: Jun 1, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Preoperative vascular dysfunction is associated with acute kidney injury after cardiac surgery
Daijiro Hori1,2, Takahiro Yamamoto1,2, Takeshi Kakiuchi1,2
1Department of Cardiovascular Surgery, Ageo Central General Hospital, Saitama, Japan.
Insights
Preoperative endothelial dysfunction, measured by flow-mediated dilation (FMD), and increased vascular stiffness, measured by pulse wave velocity (PWV), are associated with cardiac surgery-associated acute kidney injury (CSA-AKI). These vascular function assessments can help predict CSA-AKI risk in patients undergoing valve surgery.
Area of Science:
- Cardiology
- Nephrology
- Vascular Biology
Background:
- Cardiac surgery-associated acute kidney injury (CSA-AKI) is a significant complication with poor prognosis.
- Established risk factors include preoperative creatinine, cardiopulmonary bypass duration, and blood pressure management.
- The role of vascular stiffness and endothelial function in CSA-AKI remains underexplored.
Purpose of the Study:
- To investigate the association between preoperative vascular function (stiffness and endothelial function) and the incidence of CSA-AKI.
- To evaluate specific biomarkers like asymmetric dimethylarginine (ADMA) and vascular cell adhesion molecule-1 (VCAM-1) in relation to CSA-AKI.
Main Methods:
- Prospective observational study of 40 patients undergoing valve surgery.
- Preoperative measurements included flow-mediated dilation (FMD) for endothelial function and pulse wave velocity (PWV) for vascular stiffness.
- Serum biomarkers (ADMA, VCAM-1) and Kidney Disease Improving Global Outcomes (KDIGO) criteria for CSA-AKI diagnosis were used.
Main Results:
- Eleven patients (27.5%) developed CSA-AKI.
- Patients with CSA-AKI exhibited lower preoperative FMD (4.6% vs. 6.9%, P=0.009) and higher PWV (1784 vs. 1467 cm/s, P=0.02).
- Preoperative FMD was identified as an independent risk factor for CSA-AKI (OR: 0.54, P=0.049), with higher VCAM-1 levels also observed in CSA-AKI patients (P=0.03).
Conclusions:
- Preoperative vascular stiffness (PWV) and endothelial dysfunction (FMD) are significantly associated with CSA-AKI incidence.
- Biomarkers such as VCAM-1 also correlate with CSA-AKI development.
- FMD and PWV measurements may serve as valuable tools for assessing CSA-AKI risk in patients undergoing valve surgery.
Background:
Cardiac surgery-associated acute kidney injury (CSA-AKI) results in poor prognosis. Several risk factors for CSA-AKI have been reported, including preoperative creatinine level, cardiopulmonary bypass time, and perioperative blood pressure management. Only few studies have reported the effect of vascular stiffness on the incidence of CSA-AKI, and there are is no study reporting on endothelial function and its association with CSA-AKI. The purpose of this study was to evaluate the association between preoperative vascular function, including vascular stiffness and endothelial function, and incidence of CSA-AKI.
Methods:
In this prospective observational study, 40 consecutive patients undergoing valve surgery were enrolled. Flow-mediated dilation (FMD) and pulse wave velocity (PWV) were measured before surgery for the evaluation of endothelial function and vascular stiffness. Blood test was also performed for the measurement of serum biomarkers including asymmetric dimethylarginine (ADMA) and vascular cell adhesion molecule-1 (VCAM-1). CSA-AKI was diagnosed by using the Kidney Disease Improving Global Outcomes (KDIGO) criteria.
Results:
The mean age of the patients was 72±8.2 years old and 60% were male. All patients underwent valve surgery with two patients undergoing concomitant coronary artery bypass grafting. Preoperative FMD and PWV were 6.3%±2.58% and 1,554±386.6 cm/s respectively. ADMA and VCAM-1 were significantly correlated (r=0.50, P=0.001), and there was a significant correlation between FMD and ADMA (r=-0.42, P=0.007), and FMD and VCAM-1 (r=-0.42, P=0.007). Eleven patients (27.5%) developed CSA-AKI. FMD was lower in patients with CSA-AKI (no AKI: 6.9%±2.57% vs. AKI: 4.6%±1.77%, P=0.009) and PWV was higher in patients with CSA-AKI (no AKI: 1,467±296.4 cm/s vs. AKI: 1,784±506.7 cm/s, P=0.02). Further, VCAM-1 was higher in patients with CSA-AKI (no AKI: 696±247.5 ng/mL vs. AKI: 879±196.2 ng/mL, P=0.03). Multivariable analysis showed that preoperative FMD was an independent risk factor for CSA-AKI (odds ratio: 0.54, P=0.049).
Conclusions:
VCAM-1, FMD, and PWV were associated with incidence of CSA-AKI. These measurements may be useful in evaluation of potential risk of CSA-AKI in patients undergoing valve surgery.
