Analysis Of Arterial Stiffness And Associated Factors In Pre-dialysis Patients With Chronic Kidney Disease

Objective: Cardiovascular disease is the most common complication and the leading causeof death in chronic kidney disease. In recent years, the role of non-traditionalcardiovascular risk factors, such as chronic inflammation, the increased arterial stiffness,oxidative stress, hyperhomocysteinemia and hyperlipidemia are more and more attention.Arterial calcification and the increased arterial stiffness is a major predictor of themorbidity and mortality of cardiovascular disease in chronic kidney disease, especially inend stage renal disease. The purpose of this experiment is to study the arterial stiffness inpre-dialysis patients with chronic kidney disease(CKD), analysis and explore the associatedfactors, and provide targets for clinical intervention.Methods: We recruited44patients with chronic kidney disease treated in the Renal Clinicof Tongji Medical College, Huazhong University of Science&Technology, Tongji Hospital,from October2010to March2011,18healthy people in our hospital medical center wererolled in this trial. Blood pressure was measured in the early morning in quiet state,mercury sphygmomanometer was used to measure the right side of the patient‘s brachialartery, blood pressure was measured twice at intervals of30seconds, take the averageblood pressure as patient‘s blood pressure. Pulse pressure (PP) is equal to the systolic bloodpressure (SBP) minus diastolic blood pressure (DBP). Mean arterial pressure (MAP) isequal to (2times the DBP plus SBP), divided by3. Automatic pulse wave velocity (PWV) measuring system of Omron Corporation was used to examine brachial and ankle pulsewave velocity as the parameters reflecting central elastic large arterial stiffness in CKDpatients and healthy controls. Blood biochemical parameters such as serum albumin,creatinine, uric acid, serum calcium, serum phosphorus, total cholesterol, triglycerides andintact parathyroid hormone, sensitivity C-reactive protein was routinely detected. Fetuin-awas used to reflect vascular calcification. Enzyme-linked immunosorbent assay (ELISA)was used to detect the levels of serum fetuin-a. The calculation of eGFR was using theabbreviated MDRD formula based on the improvement of China’s demographic data.Stepwise multiple linear regression analysis was used to assess the associated factors ofarterial stiffness.Results: The systolic blood pressure, diastolic blood pressure, pulse pressure, mean arterialpressure and baPWV in chronic kidney disease group was significantly higher than thehealthy control group. BaPWV in stages3,4and5CKD patients was obviously higher thanin healthy controls [(15.362.03)m/s、(17.372.60)m/s、(17.041.69)m/s vs(12.441.04)m/s, all P<0.05]. BaPWV was significantly positively correlated with systolicblood pressure, mean arterial pressure, hemoglobin and CRP, but negatively correlated withfetuin-a (P <0.05). BaPWV was negatively correlated with serum calcium level, andpositively correlated with serum phosphorus level, but there was no statistical significance(P>0.05).Stepwise multiple linear regression demonstrated that systolic blood pressure, age,eGFR, fetuin-a and hsCRP were the independent influencing factors of baPWV inpre-dialysis patients with chronic kidney diseaseConclusions: Arterial stiffness significantly increases in pre-dialysis patients with chronickidney disease. Systolic blood pressure, age, eGFR, fetuin-a and hsCRP were theindependent influencing factors of baPWV in pre-dialysis CKD patients. In this group, thecalcium and phosphorus metabolism has no significant relationship with the increasedarterial stiffness.