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      Increased Arterial Stiffness after Coronary Artery Revascularization Correlates with Serious Coronary Artery Lesions and Poor Clinical Outcomes in Patients with Chronic Kidney Disease

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          Abstract

          Objectives: This study aimed to clarify the relationship between arterial stiffness and coronary artery lesions as well as their influence on long-term outcomes after coronary artery revascularization in patients with chronic kidney disease (CKD). Methods: A total of 205 patients who had a coronary angiography and received coronary artery revascularization on demand were enrolled and followed up for 5 years. Demographic and clinical indicators, arterial stiffness indexes, angiographic characteristics and the Gensini score (GS) were recorded at baseline. Major adverse cardiac events (MACE), including cardiac death and repeat coronary artery revascularization, that occurred during the 5 years of follow-up were also recorded. Results: All indexes reflecting the degree of arterial stiffness, including PWV, C1, C2, CSBP, CDBP, AP and Aix, were significantly higher in CKD than in non-CKD patients (all p < 0.05). Patients with CKD also had a higher rate of coronary artery disease and a higher GS (p < 0.05 and p < 0.01, respectively). Logistic regression analysis revealed CKD to be an independent risk factor for increased arterial stiffness (OR = 2.508, 95% CI 1.308-4.808, p = 0.006). During follow-up, CKD patients with PWV >13 m/s or Aix@75 >30 had a significantly higher MACE occurrence rate after coronary artery revascularization (both p < 0.05). Conclusion: These results highlight that CKD and arterial stiffness correlate with the severity of coronary artery lesions. CKD patients with impaired arterial stiffness have poor clinical outcomes, suggesting a further clinical use of the arterial stiffness index as a surrogate of worse cardiovascular prognosis in CKD than in non-CKD patients. i 2014 S. Karger AG, Basel

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          Most cited references 21

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          2007 ESH-ESC Practice Guidelines for the Management of Arterial Hypertension: ESH-ESC Task Force on the Management of Arterial Hypertension

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            Risk of coronary events in people with chronic kidney disease compared with those with diabetes: a population-level cohort study.

            Diabetes is regarded as a coronary heart disease risk equivalent-ie, people with the disorder have a risk of coronary events similar to those with previous myocardial infarction. We assessed whether chronic kidney disease should be regarded as a coronary heart disease risk equivalent. We studied a population-based cohort with measures of estimated glomerular filtration rate (eGFR) and proteinuria from Alberta, Canada. We used validated algorithms based on hospital admission and medical-claim data to classify participants with baseline history of myocardial infarction or diabetes and to ascertain which patients were admitted to hospital for myocardial infarction during follow-up (the primary outcome). For our primary analysis, we defined baseline chronic kidney disease as eGFR 15-59·9 mL/min per 1·73 m(2) (stage 3 or 4 disease). We used Poisson regression to calculate unadjusted rates and relative rates of myocardial infarction during follow-up for five risk groups: people with previous myocardial infarction (with or without diabetes or chronic kidney disease), and (of those without previous myocardial infarction), four mutually exclusive groups defined by the presence or absence of diabetes and chronic kidney disease. During a median follow-up of 48 months (IQR 25-65), 11,340 of 1,268,029 participants (1%) were admitted to hospital with myocardial infarction. The unadjusted rate of myocardial infarction was highest in people with previous myocardial infarction (18·5 per 1000 person-years, 95% CI 17·4-19·8). In people without previous myocardial infarction, the rate of myocardial infarction was lower in those with diabetes (without chronic kidney disease) than in those with chronic kidney disease (without diabetes; 5·4 per 1000 person-years, 5·2-5·7, vs 6·9 per 1000 person-years, 6·6-7·2; p<0·0001). The rate of incident myocardial infarction in people with diabetes was substantially lower than for those with chronic kidney disease when defined by eGFR of less than 45 mL/min per 1·73 m(2) and severely increased proteinuria (6·6 per 1000 person-years, 6·4-6·9 vs 12·4 per 1000 person-years, 9·7-15·9). Our findings suggest that chronic kidney disease could be added to the list of criteria defining people at highest risk of future coronary events. Alberta Heritage Foundation for Medical Research. Copyright © 2012 Elsevier Ltd. All rights reserved.
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              Stepwise increase in arterial stiffness corresponding with the stages of chronic kidney disease.

              Patients with end-stage renal disease on maintenance dialysis therapy have a high prevalence of cardiovascular risk factors and cardiovascular disease (CVD). A similar finding is noted in patients with chronic kidney disease (CKD). The important contributors are premature and accelerated atherosclerosis and vascular calcification. We assessed the severity of arterial stiffness in 102 patients with CKD by using pulse wave velocity (PWV) and sought to identify associated risk factors. PWV was measured by calculating the distance traveled by the flow wave and divided by the time delay. Correlations between PWV and traditional cardiovascular risk factors, estimated glomerular filtration rate (GFR) per 1.73 m2 , blood pressure (BP), and pulse pressure (PP) were analyzed. PWV values in patients with CKD stages 1 to 2 and the age-matched control group were similar. There was a significant trend for a stepwise increase in PWV corresponding to advance in CKD stage (P < 0.0001). Univariate linear regression analysis showed that age, prior CVD, diabetes, hypertension, any high risk, estimated GFR per 1.73 m2 , systolic BP, and PP correlated with PWV. In the multivariate model, decreased estimated GFR per 1.73 m2 and increased systolic BP were independently associated with increased PWV in patients with CKD (model R 2 = 0.539; P < 0.0001). This is the first study to show a greater PWV in patients with more advanced CKD from stages 1 to 5. Estimated GFR per 1.73 m2 and systolic BP were the major clinical determinants of arterial stiffness in patients with CKD independent of conventional risk factors for CVD.
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                Author and article information

                Journal
                CRM
                Cardiorenal Med
                10.1159/issn.1664-5502
                Cardiorenal Medicine
                S. Karger AG
                1664-3828
                1664-5502
                2014
                December 2014
                10 December 2014
                : 4
                : 3-4
                : 280-289
                Affiliations
                Departments of aCardiology and bHypertension, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, and cCivil Aviation Administration of China (CAAC), East China Regional Administration Aviation Personnel Examination Center, Shanghai Hospital of Civil Aviation, Shanghai, China
                Author notes
                *Ruiyan Zhang, Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Er Road, Shanghai, 200025 (China), E-Mail zhangruiyan@263.net
                Article
                369107 PMC4299172 Cardiorenal Med 2014;4:280-289
                10.1159/000369107
                PMC4299172
                25737692
                © 2014 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 1, Tables: 5, Pages: 10
                Categories
                Original Paper

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