Interrelationship between brachial artery function and renal small artery sclerosis in chronic kidney disease

Introduction: Aberrant vascular function contributes to the substantially high cardiovascular burden of chronic kidney disease (CKD). Mitochondrial derived oxidative stress is a potential therapeutic target to ameliorate CKD related vascular dysfunction. Hypothesis: We hypothesized that a mitochondrial targeted antioxidant (MitoQ) would improve vascular function in Stage 3-5 CKD patients without overt cardiovascular disease. Methods: In this controlled, double-blind trial, 18 CKD patients (Mean±SEM: Age, 62±3 years; eGFR, 45±3 ml•min•1.73 2 ) were randomized to receive an oral dose of MitoQ (20mg/day; MTQ) or a Placebo (PLB) for 4 weeks. Outcome measures were assessed at week 0 and week 4. Aortic pressure waves were synthesized from brachial artery waveforms acquired by oscillometry and the use of a generalized transfer function. The central pressure waveform was separated into forward and reflected waves using a triangular flow waveform. Conduit artery vascular function was assessed via brachial artery flow mediated dilation (FMD). Results: MitoQ was well tolerated and patient compliance was high (MTQ, 99.6±0.4%; PLB, 97.8±2.2%). Independent of peripheral (Baseline vs. Follow Up: MTQ, 140±6 vs. 137±6 mmHg; PLB, 136±4 vs. 134±6 mmHg; interaction p=0.7) and central (MTQ, 128±5 vs. 123±6 mmHg; PLB, 124±3 vs. 123±5 mmHg; interaction p=0.8) systolic blood pressures, MitoQ maintained forward wave amplitudes (MTQ, 31±3 vs. 29±1 mmHg; PLB, 29±3 vs. 36±3 mmHg; interaction p=0.05) and tended to reduce reflected wave amplitudes (MTQ, 18±2 vs. 16±1 mmHg; PLB, 19±2 vs. 21±2 mmHg; interaction p=0.04). MitoQ administration favored improvements in FMD (MTQ, 2.4±0.3 vs. 4.0±0.9%; PLB, 4.2±1.0 vs. 2.5±1.0%; interaction p=0.04). Conclusions: These results suggest that targeting mitochondrial derived reactive oxygen species holds promise as a potential therapeutic strategy to improve CKD related vascular dysfunction. Whether MitoQ related improvements in arterial hemodynamics are a result of augmented cardiac function or a reduction in vascular resistance warrants future investigation in larger studies.

Download Full-text

Risk factor profile for chronic kidney disease is similar to risk factor profile for small artery disease

Journal of Hypertension ◽

10.1097/hjh.0b013e328349052b ◽

2011 ◽

Vol 29 (9) ◽

pp. 1796-1801 ◽

Cited By ~ 9

Author(s):

Stephen T. Turner ◽

Andrew D. Rule ◽

Gary L. Schwartz ◽

Iftikhar J. Kullo ◽

Thomas H. Mosley ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Risk Factor ◽

Kidney Disease ◽

Small Artery ◽

Risk Factor Profile ◽

Artery Disease

Download Full-text

Central arterial and peripheral arterial blood pressure in patients with chronic kidney disease undergoing versus not undergoing hemodialysis

Journal of International Medical Research ◽

10.1177/0300060519895848 ◽

2019 ◽

Vol 48 (4) ◽

pp. 030006051989584

Author(s):

Liping Sun ◽

Ru Zhou ◽

Xinzhou Zhang

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Arterial Pressure ◽

Brachial Artery ◽

Control Group ◽

Cross Sectional ◽

Artery Pressure ◽

Arterial Blood ◽

The Difference ◽

Peripheral Arterial

Objective We assessed the consistency of noninvasive and invasive measurements of central arterial pressure (CAP) and the difference between peripheral brachial artery pressure and CAP in patients with chronic kidney disease (CKD) undergoing versus not undergoing hemodialysis. Methods This single-center cross-sectional study was performed from May to December 2018. The patients were divided into a control group (n = 50), CKD group (stages 3–5, n = 50), and dialysis group (n = 20), and all underwent measurement of peripheral humeral arterial pressure and noninvasive and invasive measurement of CAP. Group differences and correlations between CAP and peripheral arterial pressure were assessed. Results The consistency between noninvasive and invasive CAP was better in the control and CKD groups than in the dialysis group. In the dialysis group, the noninvasive equipment underestimated the actual CAP. The CAP was close to the peripheral brachial artery pressure in the dialysis group, while the CAP was significantly lower than the peripheral brachial artery pressure in the control and CKD groups. Conclusion Noninvasive equipment underestimates the actual CAP in patients undergoing dialysis and should be used with caution. The difference between the peripheral arterial pressure and CAP was smaller in patients undergoing dialysis than in patients with CKD and controls.

Download Full-text

Flow-mediated vasodilatation of the brachial artery in children with chronic kidney disease

Pediatric Nephrology ◽

10.1007/s00467-008-0815-0 ◽

2008 ◽

Vol 23 (8) ◽

pp. 1297-1302 ◽

Cited By ~ 16

Author(s):

Amy C. Wilson ◽

Elaine Urbina ◽

Sandra A. Witt ◽

Betty J. Glascock ◽

Thomas R. Kimball ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Brachial Artery

Download Full-text

Hyperhomocysteinemia in patients with chronic kidney disease and its relationship with the functional status of the cardiovascular system

Regulatory Mechanisms in Biosystems ◽

10.15421/021723 ◽

2017 ◽

Vol 8 (2) ◽

pp. 141-151

Author(s):

K. P. Postovitenko ◽

I. A. Iliuk ◽

S. V. Shevchuk ◽

G. V. Bezsmertna ◽

І. O. Bezsmertnyi ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Endothelial Dysfunction ◽

Kidney Disease ◽

Blood Plasma ◽

Functional Status ◽

Brachial Artery ◽

Left Ventricular ◽

Vascular Lesions ◽

Number Of Patients ◽

In Blood Plasma

Chronic kidney disease (CKD) is an important medical, social and economic problem nowadays. Patients with CKD are known to have an increased risk of development and progression of cardiovascular diseases. However, the causes and pathogenesis of cardiovascular complications are not well understood. One of the recently recognized “non-traditional” risk factors for the increased development of cardiovascular pathology in severe stages of CKD is hyperhomocysteinemia (HHC). The article presents the results of study of HHC frequency in patients with different stages of CKD as well as the relationship between HHC and endothelial dysfunction and structural-functional status of the heart. The study involved 148 persons with different stages of CKD who underwent immunoenzyme determination of total plasma homocysteine (HC), echocardiography, carotid ultrasonograghy, endothelial function was assessed as well. It was found that among the patients with CKD, 26 (21.1%) had normal and 34 (27.7%) had subnormal HC levels, mild HHC was observed in 30 (24.4%) and moderate HHC – in 33 (26.8%) cases, i.e. the total number of patients with elevated HC level was 88.9%. It should be noted that no patients with normal HC level were found among those with stage four CKD as well as in dialysis patients. The increase of blood plasma HC level was actually proportional to the severity of renal failure, which in its turn led to the shift in the number of cases towards higher rank indices of HHC level. In particular, while there were no patients with HHC among those with CKD-I, more than 50% of such patients were found in the group with CKD-V. Reduced myocardial contractility and echocardiographic markers of left ventricular hypertrophy in patients with CKD were found to be closely associated with HC concentrations in blood plasma. The data presented clearly demonstrate strong inverse correlation between endothelial dysfunction indices and HC level. So, the endothelium-dependent brachial artery vasodilation in patients with CKD-IV was lower by 3.8 and 1.5 times compared with control group and CKD-III group, respectively, and endothelium-independent vasodilation of the brachial artery – by 2.4 and 1.9 times, respectively. Correlation analysis also confirmed that impaired endothelium-dependent and endothelium-independent dilation with high statistical significance inversely correlated with the level of HC in blood plasma. Thus, the population of patients with CKD is characterized by high HHC frequency, which is closely associated with cardiovascular disorders (endothelial dysfunction, structural and functional remodelling of the myocardium) and can be an important risk factor for the development of vascular lesions. We believe that adequate correction of HHC, including administration of folic acid preparations could reduce the progression of vascular lesions in patients with CKD.

Download Full-text

Daily indices of central and peripheral blood pressure in patients with chronic glomerulonephritis and arterial hypertension at different stages of chronic kidney disease

Kazan medical journal ◽

10.17816/kmj2019-571 ◽

2019 ◽

Vol 100 (4) ◽

pp. 571-577

Author(s):

I V Polyakova ◽

N Yu Borovkova ◽

A A Tulichev ◽

T I Maslova ◽

N Yu Linyova ◽

...

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Renal Failure ◽

Kidney Disease ◽

Arterial Hypertension ◽

Brachial Artery ◽

Peripheral Blood ◽

Systolic Pressure ◽

Chronic Glomerulonephritis ◽

Peripheral Blood Pressure

Aim. To study the daily indices of central and peripheral blood pressure in patients with chronic glomerulonephritis and arterial hypertension at different stages of chronic kidney disease. Methods. 76 patients with chronic glomerulonephritis and arterial hypertension were examined: 13.2% with chronic kidney disease stage 1 (G1), 15.8% G2, 21.0% G3, 23.7% G4, 26.3% G5D. For the daily monitoring of central (in aorta) and peripheral blood pressure (in brachial artery), the BPLab monitor and the Vasotens-24 technology were used. Results. In the examined patients central and peripheral systolic, diastolic, and pulse blood pressure increased with renal function decline. Thus, the daily systolic pressure increased from 112 [107; 129] mm Hg in the aorta and 127 [118; 131] mm Hg in the brachial artery in patients with G1 to 146 [137; 153] and 147 [138; 155] mm Hg with G5D; diastolic — from 76 [70; 83] and 78 [71; 85] to 96 [82; 104] and 97 [81; 107] mm Hg; pulse pressure — from 36 [33; 45] and 48 [42; 51] to 53 [45; 56] and 62 [50; 65] mm Hg (p <0.05). A statistically significant excess of peripheral values over the corresponding parameters of central blood pressure for systolic (in groups G1–2) and pulse (G1–4) pressure was detected. Thus, in patients with G2, the average daily systolic pressure was 132 [115; 136] mm Hg in brachial artery and 113 [110; 127] mm Hg in aorta, pulse pressure — 49 [41; 52] and 33 [30; 41] mm Hg (p <0.05). With further progression of renal failure, these differences were not reliably detected. Most patients had a defect of the daily aortic and brachial blood pressure rhythm but the dipper status of systolic and diastolic blood pressure was less common than brachial one (24 and 20% versus 39 and 35%, χ2=5.21 and 5.64; p <0.05). Conclusion. The features of the peripheral and central blood pressure daily indices at different stages of chronic kidney disease in patients with chronic glomerulonephritis and arterial hypertension determine the relevance of their further study to compare the effect on cardiovascular risk and renal failure progression.

Download Full-text

A high normal ankle-brachial index is associated with biopsy-proven severe renal small artery intimal thickening and impaired renal function in chronic kidney disease

Hypertension Research ◽

10.1038/s41440-020-0443-z ◽

2020 ◽

Vol 43 (9) ◽

pp. 929-937

Author(s):

Ryo Zamami ◽

Akio Ishida ◽

Tsuyoshi Miyagi ◽

Masanobu Yamazato ◽

Kentaro Kohagura ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Renal Function ◽

Kidney Disease ◽

Impaired Renal Function ◽

Ankle Brachial Index ◽

Intimal Thickening ◽

Small Artery

Download Full-text

Relationship between plasma YKL-40 levels and endothelial dysfunction in chronic kidney disease

TURKISH JOURNAL OF MEDICAL SCIENCES ◽

10.3906/sag-1804-169 ◽

2019 ◽

Author(s):

GÜL SEMA YILDIRAN KESKİN ◽

ÖZANT HELVACI ◽

ÇAĞRI YAYLA ◽

ÖZGE TUĞÇE PAŞAOĞLU ◽

ÇAĞLAR KESKİN ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Endothelial Dysfunction ◽

Kidney Disease ◽

Brachial Artery ◽

Hemodialysis Patients ◽

Control Group ◽

Healthy Individuals ◽

Ckd Stage ◽

Flow Mediated Dilatation

Aims: We aimed to evaluate relationship between YKL-40 and endothelial dysfunction in chronic kidney disease. Patients/methods: Twenty-nine hemodialysis patients, 101 patients with non-dialytic (stage 2, 3, 4, 5ND) chronic kidney disease (CKD) and 38 healthy individuals as a control group were included. YKL-40 levels were measured with ELISA. Endothelial dysfunction was indirectly measured with Flow-mediated dilatation percentage (FMD) in the brachial artery. Results: YKL-40 levels were higher in CKD patients than controls and highest in HD patients (p=.001). Adversely FMD values were lower in non-dialytic CKD patients and lowest in HD patients (p=.001). YKL-40 negatively correlated with eGFR and FMD values (r=-0,674 and r=-0,471 respectively). Conclusion: This study shows that YKL-40 increases with CKD stage and is negatively correlated with FMD measurements.

Download Full-text