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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Usefulness of Blood Rheology as a Predictor of Primary Cardiovascular Disease Events in Patients With Stage G3
1Hitsumoto Medical Clinic, 2-7-7, Takezakicyou, Shimonoseki City, Yamaguchi 750-0025, Japan.
Insights
Impaired blood rheology, measured by whole blood passage time (WBPT), predicts cardiovascular disease (CVD) events in chronic kidney disease (CKD) patients. Higher WBPT indicates a significantly increased risk of major adverse cardiovascular events (MACEs) in stage G3 CKD.
Area of Science:
- Nephrology
- Cardiology
- Rheology
Background:
- Impaired blood rheology is linked to cardiovascular disease (CVD) and arteriosclerosis.
- The predictive value of blood rheology for CVD in chronic kidney disease (CKD) patients is not well understood.
- Stage G3 CKD is common and may benefit from CVD risk stratification.
Purpose of the Study:
- To investigate whole blood passage time (WBPT) as a predictor of primary CVD events in stage G3 CKD patients.
- To assess the utility of blood rheology in identifying high-risk individuals for CVD within the CKD population.
- To establish WBPT as a potential biomarker for CVD risk in daily clinical practice for CKD patients.
Main Methods:
- Prospective study of 417 outpatients with stage G3 CKD without prior CVD.
- Whole blood passage time (WBPT) measured using a microchannel array flow analyzer.
- Primary CVD events defined as major adverse cardiovascular events (MACEs) including cardiovascular death, ischemic heart disease, and ischemic stroke.
Main Results:
- Patients were categorized into low (WBPT ≤ 74.3s) and high (WBPT > 74.3s) groups.
- Higher WBPT was associated with a significantly higher incidence of MACEs (35.2% vs. 6.7%, P < 0.001).
- Multivariate analysis showed high WBPT (hazard ratio: 3.89) significantly increased MACE risk in stage G3 CKD patients.
Conclusions:
- Impaired blood rheology, indicated by WBPT, predicts primary CVD events in stage G3 CKD.
- WBPT may serve as a valuable tool for CVD risk assessment in CKD patients.
- Further research is needed to explore interventions improving WBPT and reducing CVD events in CKD.
Background:
Several studies have highlighted that impairment of blood rheology plays a crucial role in the development of cardiovascular disease (CVD) and arteriosclerosis. However, the value of blood rheology as a potential predictor of the development of CVD in patients with chronic kidney disease (CKD) remains unknown. The objective of this prospective study was to investigate the utility of blood rheology using whole blood passage time (WBPT) as a predictor of primary CVD events in patients with stage G3 CKD, which is often encountered in daily practice.
Methods:
This study involved 417 outpatients with stage G3 CKD (male/female: 144/273) without history of CVD. WBPT was measured by microchannel array flow analyzer as a commercial device. Subsequently, the author evaluated the effectiveness of WBPT for the prediction of primary CVD events, which were defined as major adverse cardiovascular events (MACEs, i.e., cardiovascular death, nonfatal ischemic heart disease, and non-fatal ischemic stroke).
Results:
Patients were assigned into two groups according to the WBPT cut-off value, which was estimated by receiver operating characteristic curve analysis: low (group L, WBPT ≤ 74.3 s; n = 255) or high (group H, WBPT > 74.3 s; n = 162). During the median follow-up period of 76 months (range: 2-96 months), MACEs occurred in 74 patients (group L: n = 17 (6.7%) vs. group H: n = 57 (35.2%); P < 0.001, log-rank test). Multivariate Cox regression analysis revealed that patients in group H were at a significantly higher risk of developing MACEs than those in group L (hazard ratio: 3.89; 95% confidence interval: 2.12-7.10; P < 0.001).
Conclusions:
The present findings showed that impairment of blood rheology, determined using WBPT, is predictive of primary CVD events in patients with stage G3 CKD. Further large-scale studies are warranted to confirm whether various interventions can reduce the incidence of primary CVD events with improved WBPT in patients with stage G3 CKD.
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