THE EFFECT OF ARTERIAL STIFFNESS ON DISEASE PROGRESSION AND MORTALITY IN CHRONIC KIDNEY PATIENTS

Abstract

Objective: Pulse wave velocity (PWV) is frequently used for arterial stiffness assessment in chronic renal disease (CRD). There are very few studies in the literature about the relationship between arterial stiffness and renal progression leading to mortality in CRD. Herein, we searched the relationship between arterial stiffness, and progression of kidney disease, leading to mortality in CRD patients. Methods: 194 stage 3-5 CRD patients were included in the study. The patients were followed at least four years. The primary endpoints were initiation a renal replacement treatment and death. PWV was measured using the Mobil-O-Graph NG arteriography device. Results: The study was completed with 194 patients within four years. During this period, out of 194 patients, 89 needed a renal replacement treatment (72 hemodialysis patients, 17 renal transplantation) and 15 died. Ninety of them are still being followed as predialysis CKD patient in the nephrology outpatient clinic. Increased PWV was detected as an independent predictive marker of mortality. Conclusion: Our study demonstrated that PWV might be an independent predictor of mortality. In this sense, monitoring the PWV and taking measures in this direction can reduce the effect of arterial stiffness on mortality.

Keywords

• Arterial stiffness
• mortality
• chronic renal disease

KRONİK BÖBREK HASTALIĞINDA ARTERİYEL SERTLİĞİN BÖBREK PROGRESYONU VE MORTALİTE ÜZERİNE ETKİSİ

Abstract

Amaç: Nabız dalga hızı (PWV), vasküler kalsifikasyon tanısında kullanılan elektron beam bilgisayarlı tomografi (EBCT) ile korelasyon gösterir ve kronik böbrek hastalığında (KBH) arteriyel sertlik değerlendirmesi için sıklıkla kullanılır. Literatürde KBH’ da arteriyel sertlik ile böbrek progresyonu ve mortalite arasındaki ilişki hakkında çok az çalışma vardır. Bu çalışmada KBH’da arteriyel sertlik ile böbrek hastalığının progresyonu ve mortalite arasındaki ilişkiyi araştırdık. Gereç ve Yöntem: Aralık 2014-Haziran 2015 tarihleri arasında nefroloji polikliniğine başvuran evre 3-5 kronik böbrek hastaları çalışmaya alındı. Hastalar en az dört yıl takip edildi. Birincil sonlanım noktaları bir renal replasman tedavisi başlanması (renal transplantasyon, hemodiyaliz veya periton diyalizi) ve ölümdür. Nabız dalga hızı (PWV) Mobil-O-Graph NG (Stemberg Germany Stolberg Germany) arteriograf cihazı kullanılarak ölçüldü. Bulgular: Çalışma 4 yıl boyunca düzenli kontrole gelen 194 hasta ile tamamlandı. Bu süre zarfında 194 hastanın 89’unda renal replasman tedavisi (72 hemodiyaliz, 17 renal transplantasyon) gerekti ve 15’i öldü. 90 hasta nefroloji polikliniğinde prediyaliz KBH’sı olarak izlenmektedir. Artan PWV, mortalitenin bağımsız bir prediktif belirteci olarak tespit edildi. Sonuç: Bu çalışmada, PWV’deki artışın mortalitenin bağımsız bir belirteci olduğunu bulduk. Bu anlamda, PWV’nin izlenmesinin ve bu yönde önlemler alınmasının arteriyel sertliğin mortalite üzerindeki etkisini azaltabileceğini gösterdik.

Keywords

• Arteriyel sertlik
• mortalite
• kronik böbrek hastalığı

References

1. 1. Hill NR, Fatoba ST, Oke JL, Jennifer A Hirst, Christopher A O’Callaghan, Daniel S Lasserson, et al. Global prevalence of chronic kidney disease – A systematic review and metaanalysis. PLoS one 2016;11(7):e0158765. [CrossRef]
2. 2. Feehally J, Floege J, Johnson RJ. Comprehensive Clinical Nephrology 3rd Edition. Mosby Elsevier 2007;839-40
3. 3. Landray M, Wheeler D, Lip GY, Nwman DJ, Blann AD, Mc Glynn FJ, et al. Inflammation, endothelial dysfunction, and platelet activation in patients with chronic kidney disease: The Chronic Renal Impairment in Birmingham (CRIB) Study. Am J Kidney Dis 2004;43(2):244-53. [CrossRef]
4. 4. Schwarz U, Buzello M, Ritz E, Stein G, Raabe G, Wiest G, et al. Morphology of coronary atherosclerotic lesions in patients withend-stage renal failure. Nephrol Dial Transplant 2000;15(2): 218-23. [CrossRef]
5. 5. Asmar R, Benetos A, Topouchian J, Laurent P, Pannier B, Brisac AM, et al. Assessment of arterial distensibility by automatic pulse wave velocity measurement. Validation and clinical application studies. Hypertension 1995;26:485- 90. [CrossRef]
6. 6. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003;42:1206-52. [CrossRef]
7. 7. Mancia G, De Backer G, Dominiczak A, Renata Cifkova, Robert Fagard, Giuseppe Germano, et al. 2007 Guidelines for the management of arterial hypertension: The task force for the management of arterial hypertension of the European society of hypertension (ESH) and of the European society of cardiology (ESC). Eur Heart J 2007;28(12):1462- 536. [CrossRef]
8. 8. WHO: Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation. Geneva ,WHO Technical Report Series 894, 2000.

9. 9. Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, et al. Chronic Kidney Disease Epidemiology Collaboration Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 2006;145(4):247-54. [CrossRef]
10. 10. Baumann M, Wassertheurer S, Suttmann Y, Burkhardt K, Heemann U: Aortic pulse wave velocity predicts mortality in chronic kidney disease stages 2–4. J Hypertens. 2014;32(4):899-903. [CrossRef]
11. 11. Blacher J, Safar ME, Guerin AP, Pannier B, Sylvian Marchais, Gerard M London. Aortic pulse wave velocity index and mortality in end-stage renal disease Kidney Int 2003;63(5):1852-60. [CrossRef]
12. 12. Szu-Chia Chen, Jer-Ming Chang, Wan-Chun Liu, Tsai YC, Tsai JC, Hsu PC, et al. Brachial ankle pulse wave velocity and rate of renal function decline and mortality in chronic kidney disease. Clin J Am Soc Nephrol 2011;6(4):724-32. [CrossRef]
13. 13. Briet M, Collin C, Karras A, Laurent S, Bozec E, Jacquot C, et al. Arterial remodeling associates with CKD progression. J Am Soc Nephrol 2011;22(5):967-74. [CrossRef]
14. 14. Ford ML, Tomlinson LA, Chapman TPE, Rajkumar C, Holt SG., Aortic stiffness is independently associated with rate of renal function decline in chronic kidney disease stages 3 and 4. Hypertension 2010;55(5):1110-5. [CrossRef]
15. 15. Anderson AH, Yang W, Townsend RR, Qiang Pan, Glenn M Chertow, John W Kusek, et al. Time-updated systolic blood pressure and the progression of chronic kidney disease: a cohort study. Ann Intern Med 2015 ;162(4):258-65. [CrossRef]
16. 16. Mohanram A, Zhang Z, Shahinfar S, William F Keane, Barry M Brenner, Robert D Totol . Anemia and end-stage renal disease in patients with type 2 diabetes and nephropathy. Kidney Int 2004;66(3):1131-8. [CrossRef]
17. 17. Matsushita K, van der Velde M, Astor BC, Woodward M, Levey AS, de Jong PE, et al. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: A collaborative meta-analysis. Lancet 2010:375(9731):2073- 81. [CrossRef]
18. 18. Hallan SI, Ritz E, Lydersen S, Solfrid Romundstad, Kurt Kvenild, Stephen R Orth. Combining GFR and albuminuria to classify CKD improves prediction of ESRD. J Am Soc Nephrol 2009;20(5):1069-77. [CrossRef]
19. 19. Coggins CH, Breyer Lewis J, Caggiula AW, Castaldo LS, Klahr S, Wang SR, Differences between women and men with chronic renal disease. Nephrol Dial Transplant 1998;13(6):1430-7. [CrossRef]
20. 20. Gabow PA, Johnson AM, Kaehny WD, Kimberling WJ, Lezotte DC, Duley IT, et al. Factors affecting the progression of renal disease in autosomal dominant polycystic kidney disease. Kidney Int 1992;41(5):1311-9. [CrossRef]
21. 21. Schieppati A, Mosconi, L Perna A, G Mecca, T Bertani, S Garattini, et al. Prognosis of untreated patients with idiopathic membranous nephropathy. N Engl J Med 1993;329(2):85-9. [CrossRef]
22. 22. Madsen CM, Varbo A, Nordestgaard BG. Extreme high high-density lipoprotein cholesterol is paradoxically associated with high mortality in men and women: two prospective cohort studies. Eur Heart J 2017;38(32):2478- 86. [CrossRef]
23. 23. Hamer M, O’Donovan G, Stamatakis E. High-density lipoprotein cholesterol and mortality: too much of a good thing? Arterioscler Thromb Vasc Biol 2018;38(3):669- 72. [CrossRef]
24. 24. Gulhan B, Turkmen K, Aydin M, Gunay M, Cıkman A, Kara M: The Relationship between Serum Oxalic Acid, Central Hemodynamic Parameters and Colonization by Oxalobacter formigenes in Hemodialysis Patients. Cardiorenal Med 2015;5(3):164-74. [CrossRef]