Estudio de la asociación de marcadores de rigidez arterial central y periférica con la función renal en pacientes con hipertensión arterial, diabetes mellitus y enfermedad renal crónica.

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Title:	Estudio de la asociación de marcadores de rigidez arterial central y periférica con la función renal en pacientes con hipertensión arterial, diabetes mellitus y enfermedad renal crónica.
Alternate Title:	Study of the association of markers of central and peripheral arterial stiffness with renal function in patients with arterial hypertension, diabetes mellitus and chronic kidney disease.
Authors:	Perelló Martínez, Jary¹, Michán Doña, Alfredo^2,3, Santamaría Olmo, Rafael^4,5, Hidalgo Santiago, Juan Carlos⁶, Gálvez Moral, Josefina⁷, Gómez-Fernández, Pablo⁸ pgomezf@senefro.org
Source:	Nefrologia. Nov/Dec2024, Vol. 44 Issue 6, p830-845. 16p.
Subjects:	ARTERIAL diseases, GLOMERULAR filtration rate, CHRONIC kidney failure, DISEASE risk factors, KIDNEY diseases
Abstract (English):	Rationale and objectives: Increased aortic or central arterial stiffness (CAS) is a major factor in cardiovascular morbidity and mortality in patients with vascular risk factors. Decreased glomerular filtration rate (GFR) and increased urinary albumin excretion (uALB) are associated with lethal and non-lethal cardiovascular events. The pathophysiological mechanisms of this association are not fully defined. The aim of this study was: 1.-To analyze the CAS, comparing several markers, in subjects with arterial hypertension (HTN), diabetes mellitus (DM), chronic kidney disease (CKD) and their combination. 2.-To study the possible association of CAS with renal dysfunction (decrease in GFR and increase in uALB). Material and methods: A total of 286 subjects were included, divided into several groups: Control (n: 38); HTN (n:51); DM without CKD (n:26); CKD without DM (n:77); CKD with DM (n:94). Several indices obtained by applanation tonometry were used to determine the CAS: carotidfemoral pulse velocity (VPc-f); central pulse pressure (cPP); augmentation index standardized to a cardiac frequency of 75 l/min (IA75); peripheral / aortic arterial stiffness gradient (ASGp-a). As a marker of peripheral arterial stiffness, the carotid-radial pulse velocity (PVc-r) was determined. The ASGp-a was calculated from the PVc-r/PVc-f ratio. The subendocardial viability index (iBuckberg) was obtained from the aortic pulse wave. Multiple regression, binary logistic regression, and multinomial regression were used to study the association between arterial stiffness markers and renal function. Results: The adjusted values of the PVc-f [(median (interquartile range) (m/sec)] were significantly higher in subjects with DM [(9 (1.2)], CKD [(9.4 (0.7)] and DM with CKD [(10.9 (0.7)] than in the control group [(8.2 (1.3)] and group with HTN [(8.3 (0.9)], (p:0.001). Patients with DM with CKD had higher PVc-f values than all other groups (p: 0.001). The ASGp-a of the patients was significantly lower than that of the controls, and the group with DM with CKD had significantly lower values than the other groups. The cPP in the DM with CKD group was significantly higher than in the other groups. All patients had an AI75 higher than the control group. [ABSTRACT FROM AUTHOR]
Abstract (Spanish):	Fundamento y objetivos: El aumento de la rigidez arterial central (RAC) participa en la morbimortalidad cardiovascular de los enfermos con factores de riesgo vascular. El descenso del filtrado glomerular (FG) y el aumento de la excreción urinaria de albúmina (uALB) se relacionan con eventos cardiovasculares. Los mecanismos fisiopatológicos de esta asociación no están completamente definidos. El objetivo de este estudio fue analizar la RAC, comparando varios marcadores, en sujetos con hipertensión arterial (HTA), diabetes mellitus (DM), enfermedad renal crónica (ERC) y su combinación, y estudiar la posible asociación de la RAC con la disfunción renal. Material y métodos: Se incluyeron 286 sujetos distribuidos en varios grupos: control; HTA; DM sin ERC; ERC sin DM; ERC con DM. Para la determinación de la RAC se usaron varios índices obtenidos por tonometría de aplanamiento: velocidad de pulso carótida-femoral (VPc-f) y gradiente de rigidez arterial periférica-aórtica (GRAp-a), entre otros. De la onda del pulso aórtico se obtuvo el índice de viabilidad subendocárdica (iBuckberg). Para el estudio de la asociación entre los marcadores de rigidez arterial y la función renal se usaron la regresión múltiple, la regresión logística binaria y la multinomial, todas con ajuste multivariante. Resultados: Los valores ajustados de la VPc-f (mediana [rango intercuartílico] [m/seg]) fueron significativamente mayores en los sujetos con DM (9 [1,2]); ERC (9,4 [0,7]) y DM + ERC (10,9 [0,7]) que en el grupo control (8,2 [1,3]) y grupo con HTA (8,3 [0,9]), p = 0,001. Los enfermos con DM + ERC tenían valores de VPc-f superiores a todos los demás grupos (p = 0,001). El GRAp-a de los enfermos fue significativamente inferior al de los controles, y el grupo con DM + ERC tenía valores significativamente inferiores a los de los otros grupos. La VPc-f era el único marcador de rigidez aórtica que se asociaba de forma independiente e inversa con la magnitud del FG (β = -4, p = 0,001) y predecía la presencia de disminución del FG (OR [IC 95%]: 1,50 [1,17-1,92]; p = 0,001). La VPc-f era el único índice asociado de forma directa con la cuantía de la uALB (β = 0,15; p = 0,02) y predecía la existencia de una uALB anormal (OR: 1,66 [1,25-2,20], p = 0,001). La VPc-f también se asociaba con el iBuckberg (β = -2,73; p = 0,01). En la regresión multinomial se confirmó que la VPc-f es un determinante significativo del FG y de la uALB. Por otra parte, el aumento de la VPc-f y la presencia de DM contribuían de forma significativa a la magnitud de la uALB. Conclusiones: La rigidez aórtica aumenta en presencia de factores de riesgo vascular y es mayor cuando coexisten DM y ERC. El aumento de la rigidez aórtica se asocia de forma inversa con el FG y directamente con la magnitud de la albuminuria, y tiene capacidad predictiva de una disminución del FG y de una albuminuria anormal. La VPc-f es el parámetro de rigidez aórtica que se asocia de forma más consistente con la disfunción renal. El aumento de la rigidez aórtica podría ser uno de los patomecanismos que vinculan la disfunción renal con los eventos cardiovasculares. [ABSTRACT FROM AUTHOR]
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Database:	MedicLatina

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Abstract:	Rationale and objectives: Increased aortic or central arterial stiffness (CAS) is a major factor in cardiovascular morbidity and mortality in patients with vascular risk factors. Decreased glomerular filtration rate (GFR) and increased urinary albumin excretion (uALB) are associated with lethal and non-lethal cardiovascular events. The pathophysiological mechanisms of this association are not fully defined. The aim of this study was: 1.-To analyze the CAS, comparing several markers, in subjects with arterial hypertension (HTN), diabetes mellitus (DM), chronic kidney disease (CKD) and their combination. 2.-To study the possible association of CAS with renal dysfunction (decrease in GFR and increase in uALB). Material and methods: A total of 286 subjects were included, divided into several groups: Control (n: 38); HTN (n:51); DM without CKD (n:26); CKD without DM (n:77); CKD with DM (n:94). Several indices obtained by applanation tonometry were used to determine the CAS: carotidfemoral pulse velocity (VPc-f); central pulse pressure (cPP); augmentation index standardized to a cardiac frequency of 75 l/min (IA75); peripheral / aortic arterial stiffness gradient (ASGp-a). As a marker of peripheral arterial stiffness, the carotid-radial pulse velocity (PVc-r) was determined. The ASGp-a was calculated from the PVc-r/PVc-f ratio. The subendocardial viability index (iBuckberg) was obtained from the aortic pulse wave. Multiple regression, binary logistic regression, and multinomial regression were used to study the association between arterial stiffness markers and renal function. Results: The adjusted values of the PVc-f [(median (interquartile range) (m/sec)] were significantly higher in subjects with DM [(9 (1.2)], CKD [(9.4 (0.7)] and DM with CKD [(10.9 (0.7)] than in the control group [(8.2 (1.3)] and group with HTN [(8.3 (0.9)], (p:0.001). Patients with DM with CKD had higher PVc-f values than all other groups (p: 0.001). The ASGp-a of the patients was significantly lower than that of the controls, and the group with DM with CKD had significantly lower values than the other groups. The cPP in the DM with CKD group was significantly higher than in the other groups. All patients had an AI75 higher than the control group. [ABSTRACT FROM AUTHOR]
ISSN:	02116995
DOI:	10.1016/j.nefro.2024.05.005