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Vascular health, systemic inflammation and progressive reduction in kidney function; clinical determinants and impact on cardiovascular outcomes.
Nephrol Dial Transplant. 2011 Nov; 26(11):3537-43.ND

Abstract

INTRODUCTION

Systemic inflammation, endothelial dysfunction and arterial thickening contribute to the elevated cardiovascular risk of dialysis patients. However, the course of these derangements and their relative contribution to the cardiovascular risk of nondialysed chronic kidney disease (CKD) are scarcely investigated.

METHODS

Flow-mediated dilatation (FMD) and intima-media thickness (IMT) were assessed in 304 nondialysed CKD patients Stages 1-5 (mean age 46 ± 12 years, 158 men), together with routine biochemical measurements, C-reactive protein (CRP) and insulin resistance. Patients were then followed for time-to-event analysis of cardiovascular outcomes (fatal and nonfatal).

RESULTS

CRP and IMT increased, while FMD decreased in parallel with estimated glomerular filtration rate (eGFR) decline (P < 0.001 for all). CRP and intact parathormone, as well as eGFR, appeared as strong determinants of FMD and IMT in multivariate analyses. After a median follow-up of 41 (range 6-46) months, 30 fatal and 59 nonfatal cardiovascular events occurred. In univariate analysis, FMD, IMT and CRP were significant predictors of outcome. In a multivariate Cox model excluding IMT, both FMD [hazard ratios 0.52 (95% confidence intervals 0.37-0.73) per %] and CRP [1.07 (1.03-1.11) per mg/L] predicted cardiovascular outcomes independently of confounders. In a model excluding FMD, only CRP (and not IMT) was a significant predictor.

CONCLUSIONS

Endothelial dysfunction, arterial thickening and inflammation occur in parallel with the decline in eGFR, contributing to the increased cardiovascular risk of nondialysed CKD. Our results support the use of FMD over IMT measurements to monitor nondialysed CKD patients at risk.

Authors+Show Affiliations

Department of Nephrology, Gülhane School of Medicine, Ankara, Turkey. Juan.Jesus.Carrero@ki.seNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21378154

Citation

Yilmaz, Mahmut Ilker, et al. "Vascular Health, Systemic Inflammation and Progressive Reduction in Kidney Function; Clinical Determinants and Impact On Cardiovascular Outcomes." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 26, no. 11, 2011, pp. 3537-43.
Yilmaz MI, Stenvinkel P, Sonmez A, et al. Vascular health, systemic inflammation and progressive reduction in kidney function; clinical determinants and impact on cardiovascular outcomes. Nephrol Dial Transplant. 2011;26(11):3537-43.
Yilmaz, M. I., Stenvinkel, P., Sonmez, A., Saglam, M., Yaman, H., Kilic, S., Eyileten, T., Caglar, K., Oguz, Y., Vural, A., Çakar, M., Altun, B., Yenicesu, M., & Carrero, J. J. (2011). Vascular health, systemic inflammation and progressive reduction in kidney function; clinical determinants and impact on cardiovascular outcomes. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 26(11), 3537-43. https://doi.org/10.1093/ndt/gfr081
Yilmaz MI, et al. Vascular Health, Systemic Inflammation and Progressive Reduction in Kidney Function; Clinical Determinants and Impact On Cardiovascular Outcomes. Nephrol Dial Transplant. 2011;26(11):3537-43. PubMed PMID: 21378154.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vascular health, systemic inflammation and progressive reduction in kidney function; clinical determinants and impact on cardiovascular outcomes. AU - Yilmaz,Mahmut Ilker, AU - Stenvinkel,Peter, AU - Sonmez,Alper, AU - Saglam,Mutlu, AU - Yaman,Halil, AU - Kilic,Selim, AU - Eyileten,Tayfun, AU - Caglar,Kayser, AU - Oguz,Yusuf, AU - Vural,Abdulgaffar, AU - Çakar,Mustafa, AU - Altun,Battal, AU - Yenicesu,Mujdat, AU - Carrero,Juan Jesus, Y1 - 2011/03/04/ PY - 2011/3/8/entrez PY - 2011/3/8/pubmed PY - 2012/5/31/medline SP - 3537 EP - 43 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 26 IS - 11 N2 - INTRODUCTION: Systemic inflammation, endothelial dysfunction and arterial thickening contribute to the elevated cardiovascular risk of dialysis patients. However, the course of these derangements and their relative contribution to the cardiovascular risk of nondialysed chronic kidney disease (CKD) are scarcely investigated. METHODS: Flow-mediated dilatation (FMD) and intima-media thickness (IMT) were assessed in 304 nondialysed CKD patients Stages 1-5 (mean age 46 ± 12 years, 158 men), together with routine biochemical measurements, C-reactive protein (CRP) and insulin resistance. Patients were then followed for time-to-event analysis of cardiovascular outcomes (fatal and nonfatal). RESULTS: CRP and IMT increased, while FMD decreased in parallel with estimated glomerular filtration rate (eGFR) decline (P < 0.001 for all). CRP and intact parathormone, as well as eGFR, appeared as strong determinants of FMD and IMT in multivariate analyses. After a median follow-up of 41 (range 6-46) months, 30 fatal and 59 nonfatal cardiovascular events occurred. In univariate analysis, FMD, IMT and CRP were significant predictors of outcome. In a multivariate Cox model excluding IMT, both FMD [hazard ratios 0.52 (95% confidence intervals 0.37-0.73) per %] and CRP [1.07 (1.03-1.11) per mg/L] predicted cardiovascular outcomes independently of confounders. In a model excluding FMD, only CRP (and not IMT) was a significant predictor. CONCLUSIONS: Endothelial dysfunction, arterial thickening and inflammation occur in parallel with the decline in eGFR, contributing to the increased cardiovascular risk of nondialysed CKD. Our results support the use of FMD over IMT measurements to monitor nondialysed CKD patients at risk. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/21378154/Vascular_health_systemic_inflammation_and_progressive_reduction_in_kidney_function L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfr081 DB - PRIME DP - Unbound Medicine ER -