The Relationship Between Atherosclerosis And Endothelial Dysfunction In Chronic Kidney Disease Patients In Stage One

Cardiovascular disease (CVD) is a major cause of morbidity and mortality in patients with all form of chronic kidney disease (CKD). The underlying pathological state is caused by a complex interplay of traditional and nontraditional risk factors that results in atherosclerosis, arteriosclerosis, and altered cardiac morphological characteristics. The potential involvement of the vascular endothelium in the complex disease process of atherosclerosis and its thrombotic complications has been studied for decades. Endothelial dysfunction has been proved to be an independent risk factor for CVD. Brachial artery flow-mediated dilation (FMD) has emerged as the most common assessment tool of endothelial function. And brachial FMD has also been shown to be an independent predictor of cardiovascular outcomes in some studies. ADMA is an endogenous inhibitor of NO synthase. Elevated ADMA concentrations in the blood are found in numerous diseases associated with endothelial dysfunction. Furthermore, elevated ADMA levels in blood of dialysis patients correlate significantly with the degree of arteriosclerosis and cardiovascular risk.Objective:1 To study the relationship between endothetlial and FMD, ADMA in patients in CKD stage 1.2 To investigate the association between FMD,ADMA and stiffness indexβof CKD stage 1 patients.Method:According to the definition of CKD lfrom K/DOQI guide made by American kidney foundation (NKF), we choose our 264 patients, measuring waistlines, weight, blood pressure patients, blood sugar, blood fat, uric acid, right brachial artery FMD, plasma ADMA level, then select 27 people from those 264, measured plasma ADMA level by ELISA method. All the patients measured right brachial artery stiffness indexβ. Result:In all subjects, FMD of the right forearm is negatively association with age, BMI, and stiffness indexp. After adjusting for sex, diabetes duration, hypertension, and cigrarette smoking, FMD was negatively associated with age (r=-0.143, p< 0.05), waistline (r=-0.128,P<0.05), BMI (r=-0.129, P<0.05),β(r=-0.165, P<0.01). In all subjects, bivarivate correlations analysis indicates that FMD is independent related to stiffness indexp (P<0.01) and BMI (P<0.049)Conclusion:After correction for sex, BMI,GFR, hypertension duration, and cigarette smoking, FMD is negatively associated with stiffness indexβin CKD 1 patients, suggesting endothelial dysfunction might be related to atherosclerosis in CKD 1 patients. High level of plasma ADMA was found in CKD 1 patients, but no positive association was observed between FMD and stiffness indexβ.