Albuminuria, but not estimated glomerular filtration rate, is associated with maladaptive arterial remodeling: the Hoorn Study
Albuminuria, but not estimated glomerular filtration rate, is associated with maladaptive arterial remodeling: the Hoorn Study
复制标题
DOI：
10.1097/hjh.0b013e3282f50066
复制
发表时间：
2008-04-01
影响因子：
4.9
通讯作者：
Stehouwer, Coen D. A.
中科院分区：
文献类型：
--
作者：
Hermansa, Marc M. H.;Henry, Ronald M. A.;Stehouwer, Coen D. A.
目的 动脉重塑旨在维持恒定的周壁应力 ( sigma(c))。失败的重塑过程与中风有关。关于慢性肾脏疾病和动脉重塑之间关系的数据很少。 方法 我们在一项对 806 名患者进行的基于人群的研究中调查了较低的肾小球滤过率 (GFR) 和微量白蛋白尿与颈总动脉 (CCA) 动脉重塑之间的关联。评估了 CCA 特性，包括内膜中层厚度和外膜间直径 (IAD)。计算内腔直径、周壁张力 (CWT) 和周壁应力 (sigma(c))。 GFR 通过肾病饮食修改公式估算（eGFR）。白蛋白尿以尿白蛋白/肌酐比值表示。结果 平均 eGFR 为 60.3 (+/- 10.8) ml/min/1.73m(2)；中位尿白蛋白/肌酐比率为 0.57（范围 0.10-26.6 mg/mmol）。调整年龄、性别、葡萄糖耐量状态和流行的心血管疾病后，eGFR 与 CCA 特性并不独立相关。尿白蛋白/肌酐比值（每四分位数）越大，管腔直径越大 [95% 置信区间的回归系数 beta，0.14 (0.08-0.20；P < 0.01)]、IAD [0.15(0.09-0.21；P < 0.01)]、CWT [0.95 (0.52-1.38；P < 0.01)]、CWT [0.95 (0.52-1.38；P < 0.01)] 0.01)] 和 sigma(c) [ 1.7 ( 0.5-2.9; P < 0.01)]，但不具有更大的 IMT [ 0.01 ( -0.002 - 0.02; P=0.12)]。对平均动脉压、脉压和 eGFR 的额外调整并未改变结果。结论 大量蛋白尿与 CCA 管腔直径和 IAD 的增加独立相关。此外，更多的白蛋白尿与适应不良的颈动脉重塑过程相关，如 CWT 和 sigma(c) 的增加所示。这些发现可以解释为什么微量白蛋白尿与心血管疾病，尤其是中风的风险增加相关。
Objective Arterial remodeling aims to maintain a constant circumferential wall stress ( sigma(c)). A failing remodeling process is associated with stroke. Data on the relationship between chronic kidney disease and arterial remodeling are scarce.Methods We investigated the association between a lower glomerular filtration rate ( GFR) and microalbuminuria with arterial remodeling of the common carotid artery ( CCA) in a population-based study of 806 patients. CCA properties including intima-media thickness and interadventitial diameter ( IAD) were assessed. Lumen diameter, circumferential wall tension ( CWT), and circumferential wall stress ( sigma(c)) were calculated. GFR was estimated ( eGFR) by the Modification of Diet in Renal Disease formula. Albuminuria was expressed as urinary albumin/creatinine ratio.Results Mean eGFR was 60.3 ( +/- 10.8) ml/ min/ 1.73m(2); median urinary albumin/creatinine ratio was 0.57 ( range 0.10-26.6 mg/mmol). After adjustment for age, sex, glucose tolerance status, and prevalent cardiovascular disease, eGFR was not independently associated with CCA properties. A greater urinary albumin/creatinine ratio ( per quartile) was associated with a greater lumen diameter [ regression coefficient beta with 95% confidence interval, 0.14 ( 0.08-0.20; P < 0.01)], IAD [ 0.15( 0.09-0.21; P < 0.01)], CWT [ 0.95 ( 0.52-1.38; P < 0.01)], and sigma(c) [ 1.7 ( 0.5-2.9; P < 0.01)] but not with a greater IMT [ 0.01 ( -0.002 - 0.02; P=0.12)]. Additional adjustments for mean arterial pressure, pulse pressure, and eGFR did not change the results.Conclusion Greater albuminuria is independently associated with an increase in lumen diameter and IAD of the CCA. In addition, greater albuminuria is associated with a maladaptive carotid remodeling process as shown by an increase in CWT and sigma(c). These findings may explain, why microalbuminuria is associated with a greater risk of cardiovascular disease and especially stroke.