Relationship between vascular function indexes, renal arteriolosclerosis, and renal clinical outcomes in chronic kidney disease

• Published in: Nephrology (Carlton, Vic.) Vol. 20; no. 9; pp. 585 - 590
• Main Authors: Namikoshi, Tamehachi, Fujimoto, Sohachi, Yorimitsu, Daisuke, Ihoriya, Chieko, Fujimoto, Yasuo, Komai, Norio, Sasaki, Tamaki, Kashihara, Naoki
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01.09.2015
• Subjects: Adult; Aged; Aged, 80 and over; Ankle Brachial Index; arteriolosclerosis; Arteriolosclerosis - diagnosis; Arteriolosclerosis - physiopathology; Biomarkers - blood; Biopsy; Blood Pressure; Creatinine - blood; Cross-Sectional Studies; Cystatin C - blood; Female; Glomerular Filtration Rate; Hemodynamics; Humans; Hyperlipidemias - physiopathology; Hypertension - physiopathology; Hyperuricemia - physiopathology; Kidney - pathology; Kidney - physiopathology; kidney disease; Male; Middle Aged; Renal Artery Obstruction - diagnosis; Renal Artery Obstruction - physiopathology; Renal Insufficiency, Chronic - blood; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - physiopathology; Vascular Resistance; vascular stiffness; Young Adult; vascular resistance; blood pressure; arteriolosclerosis; kidney disease; vascular stiffness
• DOI: 10.1111/nep.12483
• ISSN: 1320-5358

Aim Hypertension contributes critically to the development of renal arteriolosclerosis in chronic kidney disease (CKD), but the impact of vascular function indexes including central blood pressure on renal arteriolosclerosis has not been investigated. We determined whether vascular function indexes were related to renal arteriolosclerosis and renal clinical outcomes in CKD. Methods This cross‐sectional study was implemented in our hospital. Subjects were in‐patients with CKD aged ≥20 years who underwent a renal biopsy. Vascular function indexes included central systolic blood pressure (SBP), cardio–ankle vascular index (CAVI), and renal resistive index. Central SBP was measured non‐invasively using an automated device. Arteriolosclerosis was assessed histologically. Renal clinical outcomes included estimated glomerular filtration rate using serum creatinine (eGFRcreat) or cystatin C (eGFRcys), and the urinary albumin–creatinine ratio. Results Among vascular function indexes, central SBP was weakly correlated with renal arteriolosclerosis (n = 55). Renal arteriolosclerosis was increased in hypertensive or hyperuricaemic patients, and negatively correlated with serum high‐density lipoprotein (HDL) cholesterol and eGFRcys, which were independent risk factors for renal arteriolosclerosis in a stepwise multivariate regression analysis. Of the vascular function indexes, CAVI showed the strongest correlation with all renal clinical outcomes. Central SBP was correlated with only urinary albumin–creatinine ratio, while renal resistive index was correlated with eGFRcreat and urinary albumin–creatinine ratio. Conclusion Decreased serum HDL cholesterol was independently and most closely associated with renal arteriolosclerosis. Of the vascular function indexes, CAVI had the greatest impact on renal clinical outcomes, although it was not associated with renal arteriolosclerosis. Summary at a Glance Cross sectional study on 55 patients with biopsy‐proven CKD showing cardio–ankle vascular index associated with clinical outcomes (eGFR, ACR). Needs evaluation in prospective study with ESRD.