Arterial stiffness in predialysis patients with uremia
Arterial stiffness in predialysis patients with uremia
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DOI：
10.1111/j.1523-1755.2004.00468.x
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发表时间：
2004-03-01
影响因子：
19.6
通讯作者：
Nishizawa, Y
中科院分区：
文献类型：
--
作者：
Shinohara, K;Shoji, T;Nishizawa, Y
背景。血液透析患者的动脉壁严重硬化，主动脉脉搏波速度 (PWV) 增加，这是心血管死亡率的独立预测因子。我们比较了尿毒症患者开始血液透析治疗前与维持性血液透析患者的主动脉PWV。方法。研究对象为71名开始血液透析前的终末期肾病（ESRD）患者（预透析组）、144名维持性血液透析患者和140名健康对照者。这三组均未患有糖尿病，并且年龄和性别具有可比性。结果。血液透析组的主动脉PWV高于健康受试者，且透析前患者的主动脉PWV仍高于血液透析组。对全部受试者的多元回归分析显示，肾衰竭的存在与主动脉 PWV 升高显着相关，与年龄、性别、血压、体重指数、吸烟、高密度脂蛋白 (HDL) 和非高密度脂蛋白 (non-HDL) 胆固醇水平无关。相反，血液透析与主动脉 PWV 降低相关，与肾功能衰竭和其他因素无关。对合并尿毒症患者的进一步分析再次表明，血液透析对主动脉 PWV 的有利影响与经典危险因素、抗高血压药物（包括血管紧张素转换酶抑制剂和钙通道阻滞剂）的使用、血细胞比容、血清钙、磷、甲状旁腺激素水平以及碳酸钙的使用无关。使用稳态模型评估 (HOMA-IR) 的胰岛素抵抗与主动脉 PWV 增加相关。结论。尿毒症患者在开始血液透析治疗之前就存在主动脉僵硬，并且没有观察到血液透析的不良反应，这表明肾衰竭和/或继发于肾衰竭的代谢改变在尿毒症患者的动脉僵硬中发挥重要作用。
Background. Hemodialysis patients have advanced arterial wall stiffening as shown by increased aortic pulse wave velocity (PWV), an independent predictor of cardiovascular mortality. We compared aortic PWV of uremic patients before starting hemodialysis treatment with that of patients on maintenance hemodialysis.Methods. The subjects were 71 patients with end-stage renal disease (ESRD) before starting hemodialysis (predialysis group), 144 patients on maintenance hemodialysis, and 140 healthy control subjects. These three groups were all nondiabetic and comparable in age and gender.Results. The hemodialysis group had greater aortic PWV than the healthy subjects, and the predialysis patients showed a still higher value than the hemodialysis group. Multiple regression analysis in the total subjects revealed that the presence of renal failure was significantly associated with increased aortic PWV independent of age, gender, blood pressure, body mass index, smoking, high-density lipoprotein (HDL) and nonhigh-density lipoprotein (non-HDL) cholesterol levels. In contrast, hemodialysis was associated with decreased aortic PWV independent of renal failure and the other factors. Further analyses in the combined uremic patients again indicated the favorable impact of hemodialysis on aortic PWV independent of the classical risk factors, use of antihypertensive medications, including angiotensin-converting enzyme inhibitors and calcium channel blockers, hematocrit, serum calcium, phosphorus, parathyroid hormone levels, and the use of calcium carbonate. Insulin resistance using homeostasis model assessment (HOMA-IR) was associated with increased aortic PWV.Conclusion. Aortic stiffening was present in uremic patients before starting hemodialysis treatment and no adverse effect of hemodialysis was observed, suggesting the important roles of renal failure and/or metabolic alterations secondary to renal failure in arterial stiffness in patients with uremia.