Vascular inflammation and media calcification are already present in early stages of chronic kidney disease

• Published in: Cardiovascular pathology Vol. 27; pp. 57 - 67
• Main Authors: Benz, Kerstin, Varga, Ildiko, Neureiter, Daniel, Campean, Valentina, Daniel, Christoph, Heim, Christian, Reimann, Albrecht, Weyand, Michael, Hilgers, Karl F, Amann, Kerstin
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2017
• Subjects: Aged; Aged, 80 and over; Aorta - pathology; Chronic kidney disease; Female; Humans; Immunohistochemistry; Inflammation - pathology; Intima; Male; Media; Middle Aged; Muscle, Smooth, Vascular - pathology; Pathology; Renal Insufficiency, Chronic - pathology; Saphenous Vein - pathology; Tunica Media - pathology; Uremia; Vascular calcification; Vascular Calcification - pathology; uremia; chronic kidney disease; media; vascular calcification; intima; Vascular calcification; Intima; Media; Chronic kidney disease; Uremia
• ISSN: 1054-8807; 1879-1336
• DOI: 10.1016/j.carpath.2017.01.004

Abstract Background While patients with CKD have a high prevalence of classical coronary risk factors, there is increasing evidence that atherosclerosis is different in renal compared to non-renal patients. Therefore, the present study compares changes in different vessels obtained at cardiac surgery between patients with early and advanced CKD and non-renal control patients. Methods and Results Fifty patients undergoing cardiac bypass surgery were divided into 3 groups: (i) 24 control patients with creatinine<1.3 mg/dl, (ii) 14 patients with early CKD (creatinine 1.3–2.0 mg/dl), (iii) 12 patients with advanced CKD (creatinine>2.0 mg/dl). Aorta, A. mammaria interna and V. saphena were analysed using morphometry, Kossa stain for vascular calcification and immunohistochemistry for markers of inflammation and proosteogenic differentiation of vascular smooth muscel cells (VSMC). Thereby, aortic wall thickness, calcification score of aortic intima and of V. saphena were significantly higher in advanced CKD patients than in non-renal control patients whereas significant vascular inflammation and proosteogenic dedifferentiation of VSMC and calcification of the aortic media were already present in early CKD. Interestingly, marked calcification of the V. saphena magna was seen in advanced CKD. Of note, CaxP product correlated well with markers of inflammation, but not with calcification itself. Conclusions Early stages of CKD are already associated with local upregulation of proinflammatory and proosteogenic molecules in the vascular wall and calcification of the aortic media. These findings point to the importance of local microinflammation in CKD and may shed new light on the potentially overestimated role of the CaxP product for vessel calcification.