Department of Nephrology, Gulhane School of Medicine, Ankara, Turkey.
Am J Nephrol. 2013;37(2):126-34. doi: 10.1159/000346711. Epub 2013 Jan 31.
BACKGROUND/AIMS: The role of chronic kidney disease-mineral bone disorder (CKD-MBD) reversibility in the amelioration of vascular function and in the reduction of the risk for cardiovascular events after renal transplantation is still unknown.
We investigated the longitudinal relationship between the main biomarkers of CKD-MBD and the evolution of vascular function [flow-mediated dilatation (FMD)] after transplantation in a series of 161 patients with kidney failure maintained on chronic dialysis (5D-CKD).
Before transplantation, FMD in patients was markedly lower (-40%, p < 0.001) than in well-matched healthy subjects and increased by 27% after transplantation (p = 0.001). Fibroblast growth factor 23 (FGF23), 25-hydroxy-vitamin D (25OHVD) and serum phosphate (p < 0.01) were independently associated with simultaneous changes in FMD. Changes in classical risk factors and in risk factors related to CKD like the glomerular filtration rate, serum albumin, C-reactive protein and insulin resistance failed to independently explain the variability in FMD changes after transplantation.
Endothelium-dependent vasodilatation improves after kidney transplantation, which is parallel to the dramatic fall in FGF23, the reduction in serum phosphorus and the increase in 25OHVD levels. If these associations are causal, a part of decline in cardiovascular risk after transplantation is related to partial resolution of CKD-MBD.
背景/目的：慢性肾脏病-矿物质和骨异常（CKD-MBD）的可逆性在改善肾移植后血管功能和降低心血管事件风险中的作用仍不清楚。
我们研究了 161 例维持性慢性透析（5D-CKD）的肾衰竭患者中 CKD-MBD 的主要生物标志物与移植后血管功能（血流介导的扩张 [FMD]）演变之间的纵向关系。
移植前，患者的 FMD 明显降低（-40%，p<0.001），明显低于匹配良好的健康受试者，移植后增加了 27%（p=0.001）。成纤维细胞生长因子 23（FGF23）、25-羟维生素 D（25OHVD）和血清磷酸盐（p<0.01）与 FMD 的同时变化独立相关。经典危险因素和与 CKD 相关的危险因素（如肾小球滤过率、血清白蛋白、C 反应蛋白和胰岛素抵抗）的变化不能独立解释移植后 FMD 变化的可变性。
肾移植后内皮依赖性血管舒张功能改善，与 FGF23 显著下降、血清磷减少和 25OHVD 水平升高平行。如果这些关联是因果关系，那么移植后心血管风险的部分下降与 CKD-MBD 的部分缓解有关。
