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      Arterial aging and arterial disease: interplay between central hemodynamics, cardiac work, and organ flow—implications for CKD and cardiovascular disease

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          Abstract

          Cardiovascular disease is an important cause of morbidity and mortality in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). All epidemiological studies have clearly shown that accelerated arterial and cardiac aging is characteristic of these populations. Arterial premature aging is heterogeneous. It principally involves the aorta and central capacitive arteries, and is characterized by preferential aortic stiffening and disappearance of stiffness/impedance gradients between the central and peripheral arteries. These changes have a double impact: on the heart, upstream, with left ventricular hypertrophy and decreased coronary perfusion; and, downstream, on renal and brain microcirculation (decrease in glomerular filtration and cognitive functions). Multifactorial at origin, the pathophysiology of aortic ‘progeria' and microvascular disorders in CKD/ESRD is not well understood and should be the focus of interest in future studies.

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          Effects of aging on changing arterial compliance and left ventricular load in a northern Chinese urban community.

          A P Avolio, S G Chen, R. -P. Wang … (1983)
          Pulse wave velocity (PWV) was measured by means of transcutaneous Doppler techniques in the aorta, right arm, and right leg of 480 normal subjects of both sexes in urban Beijing, China (age range 3 to 89 years, mean age 41 +/- 20.8 SD); supine blood pressure was recorded in the brachial artery of each subject with standard sphygmomanometric procedures. Serum cholesterol was determined in a subgroup of 79 subjects (age 17 to 85 years, mean 47 +/- 26 SD). PWV (y in cm/sec) was found to vary with age (x, years) at each of the three locations according to the following regression equations: aorta, y = 9.2x + 615, r = .673 (p less than .001); right arm, y = 4.8x + 998, r = .453 (p less than .001); right leg, y = 5.6x + 791, r = .630 (p less than .001). Systolic, diastolic, mean, and pulse pressures were found to increase with age. PWV also increased with mean supine blood pressure but was not related to serum cholesterol (average 4.49 +/- 0.11 [SEM], mmol/l). Compared with that of Western populations, serum cholesterol tended to be lower at all age groups, systolic pressure higher at ages over 35 years, and PWV higher at all ages. Because change in PWV is directly related to change in arterial compliance, these results indicate that aging and not concomitant atherosclerosis (known to be rare in Asian populations) is the dominant factor associated with reduced arterial compliance and increased left ventricular load in these subjects.
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            Electron beam computed tomography in the evaluation of cardiac calcification in chronic dialysis patients.

            Ralf J. Braun, M Oldendorf, W Moshage … (1996)
            The purpose of this study was to assess the value of electron beam computed tomography in the detection of cardiac calcifications in coronaries and valves of dialysis patients and to determine the rate at which calcification progresses. Forty-nine chronic hemodialysis patients aged 28 to 74 years were compared with 102 non-dialysis patients aged 32 to 73 years with documented or suspected coronary artery disease, all of whom underwent coronary angiography. We used high-resolution electron beam computed tomography scanning to make 30 axial slices with a distance of 3 mm between each slice. The number of calcifications, the surface area, and the average and highest density values were measured. We calculated a quantitative coronary artery calcium score and assessed calcification of mitral and aortic valves. In dialysis patients, the measurements were repeated after 12 months. The coronary artery calcium score was from 2.5-fold to fivefold higher in the dialysis patients than in the non-dialysis patients. Hypertensive dialysis patients had higher calcium scores than non-hypertensive dialysis patients (P < 0.05). A stepwise, multiple regression analysis confirmed the importance of age and hypertension. No correlation between calcium, phosphate, or parathyroid hormone values and the coronary calcium score was identified; however, the calcium score was inversely correlated with bone mass in the dialysis patients (r = 0.47, P < 0.05). The mitral valve was calcified in 59% of dialysis patients, while the aortic valve was calcified in 55%. The coronary artery calcium score was correlated with aortic valvular, but not mitral valvular calcification. A repeat examination of the dialysis patients at an interval of 1 year showed a disturbing tendency for progression. Our data under-score the frequency and severity of coronary and valvular calcifications in dialysis patients, and illustrate the rapid progression of this calcification. Finally, they draw attention to hypertension as an important risk factor in this process.
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              Stiffness of capacitive and conduit arteries: prognostic significance for end-stage renal disease patients.

              Bruno Pannier, Sylvain Marchais, P Guérin … (2005)
              The aorta is the principal capacitive element of the arterial tree and its increased stiffness, determined by measurement of aortic pulse wave velocity (PWV), is a strong independent predictor of cardiovascular mortality in the general population and end-stage renal disease (ESRD) patients. Whether stiffness of ESRD patients' peripheral arteries has the same prognostic value has never been investigated. A cohort of 305 ESRD patients was followed for 70+/-49 months (mean+/-SD). Ninety-six deaths of cardiovascular origin occurred. At entry into the study, together with standard clinical and biochemical analyses, patients' aortic, brachial artery, and femorotibial PWV were determined. Based on Kaplan-Meier survival curve analyses and Cox proportional hazards analyses, adjusted for age, pulse pressure, and clinical data, aortic PWV was a significant and independent predictor of outcome. Neither brachial artery nor femotibial artery stiffness was able to predict cardiovascular outcome. Receiver operating characteristic curve analysis of aortic PWV indicated the cutoff value of 10.75 m/s, with 84% sensitivity, 73% specificity, 87% negative predictive value, and 72% positive predictive value. These results provide evidence that, in ESRD, increased stiffness of capacitive arteries, like the aorta, is an independent strong predictor of cardiovascular mortality, whereas stiffness of peripheral conduit arteries had no prognostic value.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Kidney Int Suppl
                Journal ID (iso-abbrev): Kidney Int Suppl
                Title: Kidney International Supplements
                Publisher: Nature Publishing Group
                ISSN (Print): 2157-1724
                ISSN (Electronic): 2157-1716
                Publication date (Print): June 2011
                Publication date (Electronic): 13 May 2011
                Volume: 1
                Issue: 1
                Pages: 10-12
                Affiliations
                [1 ]INSERM U970, Hôpital Européen Georges Pompidou , Paris, France
                [2 ]Clinic of Nephrology, C.I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy , Iasi, Romania
                [3 ]Renal Unit, Guy's and St Thomas' NHS Foundation Hospital, King's Health Partners , London, UK
                [4 ]Division of Internal Medicine and Nephrology, Department of Nephrology, Endocrinology and Metabolic Diseases, Medical University of Silesia , Katowice, Poland
                [5 ]Nephrology Division, Department of Medicine, Akdeniz University Medical School , Antalya, Turkey
                [6 ]Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Fundación Renal Iñigo Alvarez de Toledo , Madrid, Spain
                [7 ]INSERM ERI-12 (EA 4292) , Amiens, France
                [8 ]Amiens University Hospital and the Jules Verne University of Picardie , Amiens, France
                [9 ]Department of Clinical Science, Intervention and Technology, Karolinska Institutet , Stockholm, Sweden
                [10 ]Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat , Barcelona, Spain
                [11 ]Department of Internal Medicine IV, Saarland University Medical Centre , Homburg/Saar, Germany
                [12 ]Indiana University and VAMC , Indianapolis, Indiana, USA
                [13 ]ERA–EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam , Amsterdam, The Netherlands
                [14 ]Department of Clinical Epidemiology, Leiden University Medical Center , Leiden, The Netherlands
                [15 ]Department of Nephrology, University Medical Center , Utrecht, The Netherlands
                [16 ]Nephrology, Dialysis and Transplantation Unit and CNR-IBIM Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension , Reggio Calabria, Italy
                Author notes
                [* ]INSERM U970, Hôpital Européen Georges Pompidou , 56, Rue Leblanc, F-75373 Paris Cedex 15, France. E-mail: glondon@ 123456club-internet.fr
                Article
                Publisher Item ID: kisup20115
                DOI: 10.1038/kisup.2011.5
                PMC ID: 4089718
                PubMed ID: 25018896
                SO-VID: 3b6bbc90-2ed5-414f-b8fc-a2dbec83039a
                Copyright © Copyright © 2011 International Society of Nephrology
                History
                Categories
                Subject: Mini Review

                ScienceOpen disciplines: Nephrology
                Keywords: aging,arteriosclerosis,arterial stiffness,end-stage renal disease,pressure waves
                Data availability:
                ScienceOpen disciplines: Nephrology
                Keywords: aging, arteriosclerosis, arterial stiffness, end-stage renal disease, pressure waves

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