Please wait a minute...
Journal of ZheJiang University(Medical Science)  2016, Vol. 45 Issue (5): 508-514    DOI: 10.3785/j.issn.1008-9292.2016.09.09
    
Aortic stiffness and its influencing factors in patients with chronic kidney disease
YE Binxian, ZHAO Li, SHEN Wei, REN Yan, LIN Bo, CHEN Maosheng, TANG Junda, JIANG Xinxin, LI Yiwen, HE Qiang
Department of Nephrology, Zhejiang Provincial People's Hospital, Hangzhou 310014, China
Download: HTML (   PDF(702KB)
Export: BibTeX | EndNote (RIS)      

Abstract  

Objective: To investigate the changes of aortic stiffness and its influencing factors in patients with chronic kidney diseases (CKD). Methods: Eightyfour patients with CKD from Department of Nephrology, Zhejiang Provincial People's Hospital were divided into the dialysis group (CKD stage 5, n=48) and non-dialysis group (CKD stage 3-5, n=36). Clinical data, biochemical parameters and echocardiography findings were collected. SphygmoCor pulse wave analysis system was used to obtain pulse wave analysis (PWA) parameters including central aortic systolic blood pressure (CSP), central pulse pressure (CPP), augmented pressure (AP), augmentation index (AIX), and heart rate 75-adjusted augmentation index (HR75AIX). The influencing factors of aortic stiffness were analyzed by spearman correlation analysis and multiple regression analysis. Results: CSP, CPP, AP, AIX and HR75AIX in dialysis patients had no significant differences compared with those in non-dialysis group (all P>0.05). Spearman correlation analysis showed that CSP was positively correlated with systolic blood pressure, diastolic blood pressure, cholesterol, low-density lipoprotein cholesterol, left atrial diameter (LA),left ventricular systolic diameter (LVDs), left ventricular diastolic diameter (LVDd), and negatively correlated with calcium and hemoglobin levels. CPP was positively correlated with systolic blood pressure, age, LA, LVDd, and negatively correlated with diastolic blood pressure and hemoglobin levels. AP was positively correlated with systolic blood pressure, age, LA, LVDd, and negatively correlated with hemoglobin levels. AIX was positively correlated with systolic blood pressure, age, sodium, and negatively correlated with phosphorus levels. HR75AIX was positively correlated with systolic blood pressure, sodium, cholesterol, and negatively correlated with hemoglobin and albumin levels. Multiple regression analysis showed that higher systolic blood pressure was the independent risk factor for CSP (β=0.944, P<0.01); lower diastolic blood pressure (β=0.939, P<0.01) and higher systolic blood pressure (β=-1.010, P<0.01) were the independent risk factors for CPP; older age (β=0.237, P<0.01) and higher systolic blood pressure (β=0.200, P<0.01) were the independent risk factors for AP; higher systolic blood pressure (β=0.163 and 0.115, P<0.05 and P<0.01) and higher sodium (β=0.646 and 0.625, all P<0.05) were independent risk factors for both AIX and HR75AIX. Conclusions: No significant correlation is observed between aortic stiffness and CKD of different stages. Control blood pressure and restrict sodium intake may be effective means of delaying arterial stiffness in patients with CKD.



Key wordsKidney diseases/physiopathology      Arteriosclerosis      Blood pressure     
Received: 25 July 2016      Published: 25 September 2016
CLC:  R692  
Cite this article:

YE Binxian, ZHAO Li, SHEN Wei, REN Yan, LIN Bo, CHEN Maosheng, TANG Junda, JIANG Xinxin, LI Yiwen, HE Qiang. Aortic stiffness and its influencing factors in patients with chronic kidney disease. Journal of ZheJiang University(Medical Science), 2016, 45(5): 508-514.

URL:

http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2016.09.09     OR     http://www.zjujournals.com/med/Y2016/V45/I5/508


慢性肾脏病患者主动脉僵硬度相关指数变化及影响因素分析

目的:探讨慢性肾脏病(CKD)患者主动脉僵硬度相关指数的变化及其影响因素。方法:分析浙江省人民医院肾脏病科住院的CKD患者84例,根据是否接受透析治疗分为透析组(CKD5期,48例)和非透析组(CKD3~5期,36例)。收集患者的临床资料、生物化学指标和心脏超声检查结果,通过SphygmoCor脉搏分析系统测定动脉僵硬度相关指标中心动脉收缩压(CSP)、中心动脉脉压差(CPP)、反射波强度(AP)、主动脉增益指数(AIX)和心率75校正的增益指数(HR75AIX),并采用Spearman相关性分析和多元回归分析探索动脉僵硬度相关指标的影响因素。结果:非透析组和透析组患者的CSP、CPP、AP、AIX、HR75AIX差异均无统计学意义(均P>0.05)。Spearman相关性分析结果显示,CSP与收缩压、舒张压、胆固醇、低密度脂蛋白胆固醇、左心房内径(LA)、收缩期左心室内径(LVDs)和舒张期左心室内径(LVDd)呈正相关,与血钙、血红蛋白呈负相关;CPP与收缩压、年龄、LA、LVDd呈正相关,与舒张压、血红蛋白呈负相关;AP与收缩压、年龄、LA、LVDd呈正相关,与血红蛋白呈负相关;AIX与收缩压、年龄、血钠呈正相关,与血磷水平呈负相关;HR75AIX与收缩压、血钠、胆固醇呈正相关,与血红蛋白、白蛋白呈负相关。多元回归分析结果显示,CSP的主要影响因素为收缩压(β=0.944,P<0.01);CPP的主要影响因素为收缩压(β=0.939,P<0.01)、舒张压(β=-1.010,P<0.01);AP的主要影响因素为收缩压(β=0.200,P<0.01)、年龄(β=0.237,P<0.01);AIX的主要影响因素为收缩压(β=0.163,P<0.01)、血钠(β=0.646,P<0.05);HR75AIX的主要影响因素为收缩压(β=0.115,P<0.05)、血钠(β=0.625,P<0.05)。结论:主动脉僵硬度与CKD分期未见明显相关性,控制血压和限制钠的摄入可能是延缓CKD患者动脉僵硬度的有效手段。


关键词: 肾疾病/病理生理学,  动脉硬化,  血压 
[[1]]   GO A S, CHERTOW G M, FAN D, et al.Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization[J].N Engl J Med, 2004, 351(13):1296-1305.
[[2]]   FOLEY R N, PARFREY P S, SARNAK M J.Clinical epidemiology of cardiovascular disease in chronic renal disease[J].Am J Kidney Dis, 1998, 32(5 Suppl 3):S112-S119.
[[3]]   FELLSTRÖM B C, JARDINE A G, SCHMIEDER R E, et al.Rosuvastatin and cardiovascular events in patients undergoing hemodialysis[J].N Engl J Med, 2009, 360(14):1395-1407.
[[4]]   CHERTOW G M, BLOCK G A, CORREA-ROTTER R, et al.Effect of cinacalcet on cardiovascular disease in patients undergoing dialysis[J].N Engl J Med, 2012, 367(26):2482-2494.
[[5]]   DE ZEEUW D, AKIZAWA T, AUDHYA P, et al.Bardoxolone methyl in type 2 diabetes and stage 4 chronic kidney disease[J].N Engl J Med, 2013, 369(26):2492-2503.
[[6]]   SCHIFFRIN E L, LIPMAN M L, MANN J F.Chronic kidney disease:effects on the cardiovascular system[J].Circulation, 2007, 116(1):85-97.
[[7]]   ZOCCALI C, BENEDETTO F A, MALLAMACI F, et al.Prognostic impact of the indexation of left ventricular mass in patients undergoing dialysis[J].J Am Soc Nephrol, 2001, 12(12):2768-2774.
[[8]]   SIPAHIOGLU M H, AYBAL A, UNAL A, et al.Patient and technique survival and factors affecting mortality on peritoneal dialysis in Turkey:12 years'experience in a single center[J].Perit Dial Int, 2008, 28(3):238-245.
[[9]]   ZOUNGAS S, CAMERON J D, KERR P G, et al.Association of carotid intima-medial thickness and indices of arterial stiffness with cardiovascular disease outcomes in CKD[J].Am J Kidney Dis, 2007, 50(4):622-630.
[[10]]   王海燕.肾脏病学[M].3版.北京:人民卫生出版社, 2008:1815-1816.WANG Haiyan.Nephrology[M].3rd ed.Beijing:People's Medical Publishing House Co.Ltd, 2008:1815-1816.(in Chinese)
[[11]]   BLACHER J, GUERIN A P, PANNIER B, et al.Impact of aortic stiffness on survival in end-stage renal disease[J].Circulation, 1999, 99(18):2434-2439.
[[12]]   KARRAS A, HAYMANN J P, BOZEC E, et al.Large artery stiffening and remodeling are independently associated with all-cause mortality and cardiovascular events in chronic kidney disease[J].Hypertension, 2012, 60(6):1451-1457.
[[13]]   ROMAN M J, DEVEREUX R B, KIZER J R, et al.Central pressure more strongly relates to vascular disease and outcome than does brachial pressure:the Strong Heart Study[J].Hypertension, 2007, 50(1):197-203.
[[14]]   MCINTYRE N J, FLUCK R J, MCINTYRE C W, et al.Skin autofluorescence and the association with renal and cardiovascular risk factors in chronic kidney disease stage 3[J].Clin J Am Soc Nephrol, 2011, 6(10):2356-2363.
[[15]]   BLACHER J, GUERIN A P, PANNIER B, et al.Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease[J].Hypertension, 2001, 38(4):938-942.
[[16]]   WOODARD T, SIGURDSSON S, GOTAL J D, et al.Mediation analysis of aortic stiffness and renal microvascular function[J].J Am Soc Nephrol, 2015, 26(5):1181-1187.
[[17]]   AGABITI-ROSEI E, MANCIA G, O'ROURKE M F, et al.Central blood pressure measurements and antihypertensive therapy:a consensus document[J].Hypertension, 2007, 50(1):154-160.
[[18]]   KULLO I J, MALIK A R.Arterial ultrasonography and tonometry as adjuncts to cardiovascular risk stratification[J].J Am Coll Cardiol, 2007, 49(13):1413-1426.
[[19]]   WESTERHOF N, O'ROURKE M F.Haemodynamic basis for the development of left ventricular failure in systolic hypertension and for its logical therapy[J].J Hypertens, 1995, 13(9):943-952.
[[20]]   BRIET M, COLLIN C, KARRAS A, et al.Arterial remodeling associates with CKD progression[J].J Am Soc Nephrol, 2011, 22(5):967-974.
[[21]]   ATKINSON J.Age-related medial elastocalcinosis in arteries:mechanisms, animal models, and physiological consequences[J].J Appl Physiol (1985), 2008, 105(5):1643-1651.
[[22]]   AMES R S, LI Y, SARAU H M, et al.Molecular cloning and characterization of the human anaphylatoxin C3a receptor[J].J Biol Chem, 1996, 271(34):20231-20234.
[[23]]   MESSERLI F H, SCHMIEDER R E, WEIR M R.Salt:a perpetrator of hypertensive target organ disease?[J].Arch Intern Med, 1997, 157(21):2449-2452.
[[24]]   HE F J, MARCINIAK M, VISAGIE E, et al.Effect of modest salt reduction on blood pressure, urinary albumin, and pulse wave velocity in white, black, and Asian mild hypertensives[J].Hypertension, 2009, 54(3):482-488.
[1] LIU Ke-qin, CHEN Qing-meng, YAN Shen-qiang, ZHANG Sheng, LOU Min. Relationship between early blood pressure variability and reperfusion in acute ischemic stroke patients with intravenous thrombolysis[J]. Journal of ZheJiang University(Medical Science), 2015, 44(6): 603-610,617.
[2] LIU Ming, JIN Yu-hong, LI Tiao-hong, SHI Lin-hui, ZHU Bao-qi . Effect of simvastatin on atherosclerosis and central aortic pressure in ApoE gene knockout mice[J]. Journal of ZheJiang University(Medical Science), 2014, 43(3): 293-298.
[3] YE Ping-xian,YE Ping-zhen,ZHU Jian-hua, CHEN Wei, GAO Dan-chen. Effect of atorvastatin on exercise tolerance in patients with diastolic dysfunction and exerciseinduced hypertension[J]. Journal of ZheJiang University(Medical Science), 2014, 43(3): 298-304.
[4] YUAN Qi-Yi, ZHANG Wei-Ping. Effects of recombinant human NAMPT on physiological/biochemical indexes and brain structure in mice[J]. Journal of ZheJiang University(Medical Science), 2013, 42(3): 303-310.
[5] . Changes of blood pressure,blood glucose and blood lipids levels after intensive treatment in incipient diabetes II patients[J]. Journal of ZheJiang University(Medical Science), 2010, 39(2): 198-201.
[6] Zhou Suya, Huang Deming, Chen Yingcheng. γ-aminobutyric Acid Receptor-Mediated Mechanisms in Regulation of Cardiovascular Activities in the Rostral Ventrolateral Medulla of Rats[J]. Journal of ZheJiang University(Medical Science), 1998, 27(5): 193-196.
[7] Gao Danchen, Zhu Jianhua. THE FEATURE AND SIGNIFICANCE OF MILD AND MODERATE PRIMARY HYPERTENSION AND RENAL HYPERTENSION IN AMBULATORY BLOOD PRESSURE[J]. Journal of ZheJiang University(Medical Science), 1997, 26(5): 216-218.
[8] Ye Lingdi, Zhao Li, He Junling. THE RELATION OF NYCHTHEMERAL RHYTHM OF BLOOD PRESSURE AND THE LEFT VENTRICULAR HYPERTROPHY[J]. Journal of ZheJiang University(Medical Science), 1997, 26(3): 129-131.
[9] Hu Shenjiang, Huang Yuanwei, Chen Yilun, et al. RELATIONSHIP OF CATIONS IN LYMPHOCYTES WITH BLOOD PRESSURE IN HYBRID SHR-SD RATS[J]. Journal of ZheJiang University(Medical Science), 1996, 25(5): 207-209.
[10] Shu Jing, Zhang Rongbao, Zhou Suya, et al. ISCHEMIC ELECTROCARDIOGRAPHIC CHANGES INDUCED BY STIMULATION OF THE HABENULAR NUCLEUS IN RABBITS[J]. Journal of ZheJiang University(Medical Science), 1996, 25(4): 145-148.
[11] Han Yang. DEVICE AND CLINICAL APPLICATION OF HUMAN ARTERIAL PULSE WAVE TRANSMISSION SYSTEM[J]. Journal of ZheJiang University(Medical Science), 1992, 21(4): 156-160.
[12] Chen Zhixiong, Zhang Rongbao. EFFECT OF ELECTRIC STIMULATION OF SOME MAJOR NUCLEI IN ROSTRAL VENTROLATERAL MEDULLA ON CARDIOVASCULAR ACTIVITIES[J]. Journal of ZheJiang University(Medical Science), 1992, 21(3): 97-100.