Cerebral and renal hemodynamics: similarities, differences, and associations with chronic kidney disease and aortic hemodynamics
Cerebral and renal hemodynamics: similarities, differences, and associations with chronic kidney disease and aortic hemodynamics
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脑和肾的血流动力学：与慢性肾脏病及主动脉血流动力学的相似性、差异性及关联
DOI：
10.1038/s41440-022-00944-x
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发表时间：
2022-06-03
影响因子：
5.4
通讯作者：
Maeda, Seiji
中科院分区：
文献类型：
--
作者：
Kosaki, Keisei;Tarumi, Takashi;Maeda, Seiji
动脉搏动升高是脑血管疾病和慢性肾脏疾病（CKD）的常见危险因素，这表明大脑和肾脏可能具有相似的血流动力学特征。本研究的目的有两个：1)比较和对比无CKD成人（以下简称非CKD成人）和CKD患者的脑和肾血流参数；2)确定压脉性和几种心血管危险因素中脑和肾血流动力学的共同预测因子。对110例非CKD成人和66例CKD患者分别采用经颅多普勒超声和双工超声测量脑和肾血流速度（BFV）。采用脉动性（PI）和阻力性（RI）指标评价脉搏血流动力学。采用血压计测量主动脉脉压。与非CKD成人相比，CKD患者在肾脏中表现出更大的BFV（即收缩期减去舒张期BFV）、PI和RI的搏动性，但在大脑中没有。然而，在非CKD成人（PI和RI值均r(s) = 0.695）和CKD患者（PI和RI值均r(s) = 0.640）中，脑和肾PI和RI值均强相关（均P < 0.001）。多元线性回归分析进一步表明，在调整潜在协变量（如年龄、性别、是否存在CKD）后，脑和肾PI和RI的相关性仍然显著。主动脉脉压是脑和肾PI和RI值的重要预测因子。总的来说，我们的研究结果表明CKD患者具有较高的肾血流脉搏，这与脑血流脉搏和主动脉血流动力学密切且独立相关。
Elevated arterial pulsatility is a common risk factor for cerebrovascular disease and chronic kidney disease (CKD), which suggests that the brain and kidneys may have similar hemodynamic profiles. The objectives of this study were twofold: 1) to compare and contrast the cerebral and renal blood flow parameters in adults without CKD (hereafter, non-CKD adults) and CKD patients and 2) to determine the common predictor(s) of cerebral and renal hemodynamics among pressure pulsatility and several cardiovascular risk factors. In 110 non-CKD adults and 66 CKD patients, cerebral and renal blood flow velocity (BFV) were measured by transcranial Doppler and Duplex ultrasonography, respectively. Pulsatile hemodynamics were assessed by the pulsatility (PI) and resistive (RI) indices. Aortic pulse pressure was measured by tonometry. Compared with non-CKD adults, CKD patients showed greater pulsatility of the BFV (i.e., systolic minus diastolic BFV), PI, and RI in the kidneys but not the brain. However, the cerebral and renal PI and RI values were strongly correlated in both non-CKD adults (both PI and RI values: r(s) = 0.695) and CKD patients (both PI and RI values: r(s) = 0.640) (all P < 0.001). Multiple linear regression analysis further demonstrated that the cerebral and renal PI and RI associations remained significant after adjustment for potential covariates (e.g., age, sex, the presence of CKD). The aortic pulse pressure was a significant predictor for both cerebral and renal PI and RI values. Collectively, our findings suggest that CKD patients have higher renal flow pulsatility, which is strongly and independently associated with cerebral flow pulsatility and aortic hemodynamics.