Vascular Echo-tracking Technology Detecting Arterial Elasticity Of Chronic Kidney Disease Patients

Objective: Cardiovascular complication is one of the main causes of death of Chronic Kidney Disease(CKD) patients. It is fully confirmed that each clinical phase of kidney disease may damage the artery and the damage occurs before the artery morphological changes. The traditional vascular Imaging examination basing on morphological changes can not diagnose the disease in time. In this paper, the study analyses the laws of early artery pathological changes of CKD patients by detecting the change of elasticity, morphology and structure of carotid and radial artery with Vascular echo-tracking technology and two-dimensional or Doppler ultrasound. The study provides the predictor and the basis of early clinical diagnosis and therapy for CKD, through assessing the laws of artery pathological changes at different stages of CKD and inferring their effects on the cardiovascular system.Methods:1. Select 100 CKD hospitalized patients as cases that were diagnosed in Hebei Medical University from December, 2008 to December,2009,common carotid artery (CCA ) and radial artery (RA) each 100 article.The CKD patients are divided into 5 groups according to the international common clinical staging standards (K/DOQI) basing on the life quality of CKD patients, each of which includes 20 cases. The control group includes 30 healthy cases in the same period.2. With ALOKAα-10 Color Doppler ultrasound, detect the CCA and RA of each group of CKD patients, measure the blood vessel Inner Diameter (D), Intima-media thickness(IMT), Peak systolic blood flow velocity(PSV), early diastolic reverse flow velocity(Vr), End Diastolie veloeiyt(EDV), Blood resistent index(RI), Blood pulsatility index(PI). Observe the two-dimensional structure of CAA and RA in order to see whether IMT gets thicker and whether there is plaque and the number of plaque, to find whether there is the stenosis and occlusion and abnormal blood flow waveforms.3. Detect the changing laws of two-dimensional blood vessel lumen (D,IMT) and blood flow dynamics (RI, PI) of CCA and RA. Compare them between CKD groups with the control group.4. Combine and regroup the CKD stage groups that have no significant difference in statistics, and then compare between the new groups. Analyse the D,IMT,RI,PI parameters change laws of new CKD groups.5. With application of echo-tracking technology(ET), detect the elastic parameters of CCA and RA of CKD patients. The parameters include Stiffness parameter(β), pressure-strain elasticty modulus(Ep), arterial compliance (AC), augmentation velocity index(AI), one-point pulse wave velocity (PWVβ).6. Compare theβ, Ep, AC, PWVβchange laws of the CCA and RA in different period of CKD patients. Compare CKD group with the control group. 7. Combine and regroup the CKD staging groups that has no significant difference in statistics. Further analyse theβ,Ep,AC,PWVβchange laws of different new groups.Results:1. The Intima-media thickness(IMT) is irregularly thickened, echo enhanced, not smooth for CKD group, especially for CKD3,4,5 stage group(moderate or severe renal impairment group), compared with the control group. Some CKD patients can be seen with a single or multiple, varying morphological plaque in the blood vessel lumen.2. The diameter of CCA becomes longer, the diameter of RA becomes shorter, the IMT of CCA/RA increases, RI/PI of blood flow get higher for CKD patient groups, especially for CKD3, 4,5, ( P <0.05), compared with the control group.3. Combine the CKD patients whose parameters showed no significant change in statistics, and regroup them according to mild renal injury group (CKD1, 2), moderate renal impairment group(CKD3), severe renal impairment group (CKD4, 5). Through pairwise comparison between new recombined groups, it can be observed that whether for the mild groups (CKD1, 2 group) or for the moderate or severe groups (CKD3, 4,5 group), the IMT, RI , PSV, PI of CCA and RA all increase and the difference is significant ( P <0.05). The changes of the parameter is consistent with CKD stages of disease course.4. Artery elasticity indexβ, Ep, PWVβgradually increased, and AC value gradually lower in CKD group, especially in CKD3, 4,5 ( P <0.05).5. Combine the CKD patients whose parameters showed no significant change in statistics, and regroup them according to mild renal injury group (CKD1, 2), moderate renal impairment group(CKD3), severe renal impairment group (CKD4, 5). Through pairwise comparison between new recombined groups, it can be observed that for moderate group(CKD3),β/Ep/PWVβ/AC of RA all have significant abnormal changes, which is more meaningful in statistics than the mild groups (P <0.05); Only PWVβof CCA has abnormal change for moderate group, which is of statistical significance compared with the wild groups ( P <0.05); and the changes ofβ, Ep, AC parameters is only meaningful statistically in severe renal injury group ( P <0.05).Conclusion:1. Through ultrasound examination, we can find the morphologic, structural and hemodynamic change of carotid artery and radial artery. Then we can find early pathological changes of arteriosclerosis. The detection rate of vascular disease improved significantly in CKD patients. They provide the basis for detecting and taking measures of vascular pathological changes in the early clinical stage.2. IMT,RI,PI of artery of moderate or severe renal impairment patients(CKD3, 4,5 group) has significant change. IMT is getting thicker, RI and PI are getting bigger with the development of CKD course. It can be used for assessing the development of the courses of CKD. 3. The change of artery elasticity occurred before the change of arterial wall morphology for CKD patients. Vascular echo-tracking technology can be a good early detection of artery elasticity changes of chronic kidney disease (CKD) patients, which is simple and practical method to evaluate early atherosclerosis.4. The CCA(as the elastic arteries), and RA(as the muscular arteries) of CKD patients, is lower than those of normal subjects. RA flexibility change can provide reference for the fistula plasty preoperative evaluation of end-stage CKD patients.5. Atherosclerosis occurs in the early stage of CKD, that is manifested as the changes in arterial elasticity.β,Ep,PWVβvalue increase and AC value decrease according to ET detection result. Arterial elasticity differences is more significant between the two CKD patient groups which is regrouped in accordance with the extent of renal injury. ET technique not only can accurately reflect the changes of arterial elasticity, but also as a clinical follow-up indicators, providing the basis for detecting and taking measures of vascular pathological changes in the early clinical stage.6. The parametersβ, of Ep, PWVβand AC of RA part has significant changes in the moderate stage of renal injury stage (CKD3 period), which is earlier than the parameter changes of CCA. So it is possible that muscular peripheral artery may be the more sensitive indicators reflecting the early changes in arterial elasticity.