Arterial Remodeling Associates with CKD Progression
Arterial Remodeling Associates with CKD Progression
复制标题
DOI：
10.1681/asn.2010080863
复制
发表时间：
2011-05-01
影响因子：
13.6
通讯作者：
Boutouyrie, Pierre
中科院分区：
文献类型：
--
作者：
Briet, Marie;Collin, Cedric;Boutouyrie, Pierre
在CKD中，大动脉重塑并变得越来越僵硬。由于主动脉僵硬度增加，到达肾小球的脉动压力更大，可能会引起肾损伤，这表明大动脉的硬化和重塑可能会影响CKD的进展。我们测量了180例CKD患者的颈动脉-股动脉脉搏波速度、主动脉压、颈动脉重塑和僵硬度参数（平均测量GFR，32 ml/min/1.73 m2），并对他们进行了平均3.1年的前瞻性随访。随访期间，颈动脉僵硬度显著增加（+0.28 +/- 0.05 m/s; P < 0.0001），但主动脉僵硬度没有增加。随访期间颈动脉内膜-中层厚度显著降低，颈动脉内径增加，周向壁应力增加（+2.08 +/- 0.43 kPa/yr; P < 0.0001）。在线性混合模型中，在调整心血管疾病和CKD进展的风险因素后，环周壁应力与GFR下降更快显著相关。在多变量考克斯模型中，颈动脉周壁应力和脉压独立地与ESRD的高风险相关。动脉硬度参数均与CKD进展无关。总之，颈动脉适应不良性重塑和脉压增加与肾功能更快下降和进展为终末期肾病独立相关。
In CKD, large arteries remodel and become increasingly stiff. The greater pulsatile pressure reaching the glomerulus as a result of increased aortic stiffness could induce renal damage, suggesting that the stiffening and remodeling of large arteries could affect the progression of CKD. We measured carotid-femoral pulse wave velocity, aortic pressure and carotid remodeling and stiffness parameters in 180 patients with CKD (mean measured GFR, 32 ml/min per 1.73 m(2)) and followed them prospectively for a mean of 3.1 years. During follow-up, carotid stiffness significantly increased (+0.28 +/- 0.05 m/s; P < 0.0001) but aortic stiffness did not. Carotid intima-media thickness decreased significantly during follow-up and the internal diameter of the carotid increased, producing increased circumferential wall stress (+2.08 +/- 0.43 kPa/yr; P < 0.0001). In a linear mixed model, circumferential wall stress significantly associated with faster GFR decline after adjustment for risk factors of cardiovascular disease and progression of CKD. In a multivariable Cox model, carotid circumferential wall stress and pulse pressure independently associated with higher risk for ESRD. None of the arterial stiffness parameters associated with progression of CKD. In conclusion, maladaptive remodeling of the carotid artery and increased pulse pressure independently associate with faster decline of renal function and progression to ESRD.