Key vascular function parameters may predict eGFR decline in African American patients
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A study of 2,244 African American patients demonstrated certain markers of vascular function, including greater arterial stiffness and pulsatility, were associated with worsening kidney function as measured by eGFR and albuminuria.
The findings led Harsha S. Nagarajarao, MD, FACC, of Texas Tech University of Health Sciences in the department of medicine in El Paso, Texas, and colleagues to suggest that vascular function assessments may help predict the risk for the development and progression of kidney disease in this patient population.
“Findings in the current investigation show a strong link between vascular stiffness, pulsatility and kidney disease,” the researchers wrote. “Abnormal vascular function parameters predate clinical syndromes such as CKD, stroke, and coronary artery disease and recent studies demonstrate that arterial stiffening is an early sign of cardiovascular dysfunction in CKD, often detectable before changes in diastolic function and ejection fraction. Identification and quantification of aortic stiffness in this early pathophysiologic phase may help identify these changes in microcirculation and act as an attractive imaging biomarker given the expense associated with invasive approaches to measure aortic stiffness such as cardiac catheterization which also carries some risk associated with the procedure. Evaluation of vascular function parameters, which pre-date clinical disease syndromes, may have implications for prevention, treatment and interventional studies.”
For the study, researchers conducted a cross-sectional cohort analysis of data from the Jackson Heart Study and included participants who had undergone a noninvasive hemodynamic assessment using arterial tonometry (patients who had an eGFR less than 15 mL/min/1.73 m2 at baseline were excluded; mean age was 66 years; 64% were women).
Of total participants included in the analysis, 233 or 10.4% had a reduced eGFR (defined as eGFR between 15 mL/min/1.73 m2 and 60 mL/min/1.73 m2) and 232 had an elevated urine albumin to creatinine ratio.
Results indicated that both greater arterial stiffness and pulsatility were associated with an increased likelihood of reduced kidney function.
More specifically, higher carotid-femoral pulse wave velocity conferred 1.37 greater odds of reduced eGFR and 1.66 greater odds of prevalent albuminuria. Higher forward wave amplitude was also significantly associated with prevalent albuminuria (odds ratio=1.37).
“[F]indings suggest that increased stiffness and pulsatility may result in small vessel damage and subsequent kidney disease. In particular, male sex and diabetes seem to play a critical role in the relation linking vascular stiffness and pulsatility to kidney disease in this population,” Nagarajarao and colleagues wrote. “Our study should further stimulate future studies to investigate interactions between pre-clinical determinants which lead to more advanced CKD stages. Further studies are also warranted to assess whether improving arterial stiffness could contribute to kidney protection in African Americans.”
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