Department of Pharmacology and Institut National de la Santé et de la Recherche Médicale U970-PARCC, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, 20, rue Leblanc, 75015 Paris, France;
J Am Soc Nephrol. 2011 May;22(5):967-74. doi: 10.1681/ASN.2010080863. Epub 2011 Apr 14.
In CKD, large arteries remodel and become increasingly stiff. The greater pulsatile pressure reaching the glomerulus as a result of increased aortic stiffness could induce renal damage, suggesting that the stiffening and remodeling of large arteries could affect the progression of CKD. We measured carotid-femoral pulse wave velocity, aortic pressure and carotid remodeling and stiffness parameters in 180 patients with CKD (mean measured GFR, 32 ml/min per 1.73 m(2)) and followed them prospectively for a mean of 3.1 years. During follow-up, carotid stiffness significantly increased (+0.28 ± 0.05 m/s; P<0.0001) but aortic stiffness did not. Carotid intima-media thickness decreased significantly during follow-up and the internal diameter of the carotid increased, producing increased circumferential wall stress (+2.08 ± 0.43 kPa/yr; P<0.0001). In a linear mixed model, circumferential wall stress significantly associated with faster GFR decline after adjustment for risk factors of cardiovascular disease and progression of CKD. In a multivariable Cox model, carotid circumferential wall stress and pulse pressure independently associated with higher risk for ESRD. None of the arterial stiffness parameters associated with progression of CKD. In conclusion, maladaptive remodeling of the carotid artery and increased pulse pressure independently associate with faster decline of renal function and progression to ESRD.
在 CKD 中，大动脉会发生重塑并变得越来越僵硬。由于主动脉僵硬导致到达肾小球的脉动压力增加，可能会导致肾脏损伤，这表明大动脉的僵硬和重塑可能会影响 CKD 的进展。我们测量了 180 例 CKD 患者（平均估算肾小球滤过率为 32ml/min/1.73m2）的颈股脉搏波速度、主动脉压力和颈动脉重塑及僵硬度参数，并前瞻性随访了平均 3.1 年。在随访期间，颈动脉僵硬度显著增加（0.28±0.05m/s；P<0.0001），但主动脉僵硬度没有增加。颈动脉内膜中层厚度在随访期间显著下降，颈动脉内径增加，导致周向壁应力增加（2.08±0.43kPa/yr；P<0.0001）。在线性混合模型中，校正心血管疾病危险因素和 CKD 进展后，周向壁应力与肾小球滤过率下降速度显著相关。在多变量 Cox 模型中，颈动脉周向壁应力和脉压与 ESRD 风险增加独立相关。没有任何动脉僵硬度参数与 CKD 进展相关。总之，颈动脉的适应性重塑和脉压增加与肾功能下降和进展至 ESRD 的速度独立相关。
