Endothelial dysfunction, inflammation and atherosclerosis in chronic kidney disease – a cross-sectional study of predialysis, dialysis and kidney-transplantation patients

• Published in: Atherosclerosis 2011-06, Vol.216 (2), p.446-451
• Main Authors: Recio-Mayoral, Alejandro, Banerjee, Debasish, Streather, Chris, Kaski, Juan Carlos
• Format: Article
• Language: English
• Subjects: Aged; atherosclerosis; Atherosclerosis (general aspects, experimental research); Atherosclerosis - blood; Atherosclerosis - pathology; Biological and medical sciences; Blood and lymphatic vessels; C-reactive protein; C-Reactive Protein - metabolism; Cardiology. Vascular system; Cardiovascular; Cardiovascular system; carotid arteries; Carotid Arteries - pathology; Carotid intima media thickness; Case-Control Studies; cholesterol; Chronic kidney disease; Cross-Sectional Studies; dialysis; Endothelial Cells - cytology; Endothelial function; Female; Flow mediated dilation; foot-and-mouth disease; gender; Glomerular Filtration Rate; High sensitivity C-reactive protein; Humans; Inflammation; Inflammation - blood; Inflammation - pathology; kidney diseases; Kidney Failure, Chronic - blood; Kidney Failure, Chronic - pathology; Kidney Failure, Chronic - therapy; kidney transplant; Kidney Transplantation; Male; Medical sciences; Middle Aged; morbidity; mortality; patients; Pharmacology. Drug treatments; Prospective Studies; Vasodilator agents. Cerebral vasodilators
• ISSN: 0021-9150; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2011.02.017

Abstract Background Cardiovascular morbidity and mortality are high in chronic kidney disease (CKD) patients compared to the general population. Systemic inflammation may contribute to endothelial dysfunction and accelerated atherosclerosis in CKD patients. We assessed the relationship among, endothelial dysfunction, early atherosclerosis and inflammation in predialysis, dialysis and post kidney-transplantation CKD patients. Methods and results We studied 76 consecutive CKD patients; 38 predialysis, 18 haemodialysis and 22 kidney-transplant patients. A group of 65 age and gender matched controls were also studied. In both patients and controls, high-sensitivity C-reactive protein (CRP) levels, systemic endothelial function (brachial artery flow mediated dilation, FMD,%) and carotid artery intima-media thickness (IMT, mm) were measured. CKD patients had increased CRP levels (3.7 [1.0–6.0]mg/L vs 1.0 [0.5–2.1]mg/L; p < 0.001), reduced FMD (2.2 [1.0–4.0] vs 5.6 [4.4–7.1]; p < 0.001) and increased IMT (0.82 ± 0.21 vs 0.67 ± 0.16; p < 0.001) values compared to controls. In CKD patients, a significant negative correlation was found between CRP levels and FMD responses ( r = −0.51; p < 0.001) while a significant positive correlation was found between CRP and IMT values ( r = 0.50; p < 0.001). Increased CRP levels were an independent predictor of both abnormal FMD and IMT after adjusting for age, systolic and diastolic BP and total cholesterol. Compared with predialysis and kidney-transplant patients, haemodialysis subjects had significantly lower FMD and higher CRP and IMT values. Conclusions CKD patients taken together have a higher inflammatory status compared to controls. Abnormal FMD responses and IMT values are more commonly found in dialysis patients. Our findings suggest that endothelial dysfunction and atherosclerotic changes correlate with inflammation.