CHU de Québec Research Center, L’Hôtel Dieu de Québec Hospital Quebec, Quebec, Canada.
Hypertension. 2013 Jul;62(1):154-60. doi: 10.1161/HYPERTENSIONAHA.113.01200. Epub 2013 May 6.
Aortic stiffness is associated with increased cardiovascular mortality in patients with chronic kidney disease. However, the rate of progression of arterial stiffness and the role of cardiovascular risk factors in the progression of arterial stiffness has never been established in a longitudinal study. In a prospective, longitudinal, observational study, carotid-femoral pulse wave velocity and carotid-radial pulse wave velocity were assessed in 109 hemodialysis patients at baseline and after a mean follow-up of 1.2 years. We examined the impact of age, atherosclerotic cardiovascular disease, diabetes mellitus, dialysis vintage, and pentosidine (a well-characterized, advanced glycation end products) on the rate of progression of aortic stiffness. The annual rate of changes in carotid-femoral pulse wave velocity and carotid-radial pulse wave velocity were 0.84 m/s per year (95% confidence interval, 0.50-1.12 m/s per year) and -0.66 m/s per year (95% confidence interval, -0.85 to -0.47 m/s per year), respectively. Older subjects, and patients with diabetes mellitus or atherosclerotic cardiovascular disease had higher aortic stiffness at baseline, however, the rate of progression of aortic stiffness was only determined by plasma pentosidine levels (P=0.001). The degree of baseline aortic stiffness was a significant determinant of the regression of brachial stiffness (P<0.001) suggesting that the regression of brachial stiffness occurs in response to central aortic stiffness. These findings suggest that traditional cardiovascular risk factors may play some role in the progression of aortic stiffness before development of advanced chronic kidney disease, and that the enhanced rate of progression of aortic stiffness in chronic kidney disease patients on dialysis are probably determined by more specific chronic kidney disease-related risk factors such as advanced-glycation end products.
主动脉僵硬与慢性肾脏病患者心血管死亡率的增加有关。然而，在一项纵向研究中，从未确定动脉僵硬的进展速度以及心血管危险因素在动脉僵硬进展中的作用。在一项前瞻性、纵向、观察性研究中，在基线时和平均 1.2 年的随访后，评估了 109 例血液透析患者的颈股脉搏波速度和颈桡脉搏波速度。我们检查了年龄、动脉粥样硬化性心血管疾病、糖尿病、透析年限和戊糖（一种特征明确的晚期糖基化终产物）对主动脉僵硬进展速度的影响。颈股脉搏波速度和颈桡脉搏波速度的年变化率分别为 0.84 m/s/年（95%置信区间，0.50-1.12 m/s/年）和-0.66 m/s/年（95%置信区间，-0.85 至-0.47 m/s/年）。年龄较大的患者以及患有糖尿病或动脉粥样硬化性心血管疾病的患者在基线时具有更高的主动脉僵硬程度，但是主动脉僵硬的进展速度仅由血浆戊糖水平决定（P=0.001）。基线主动脉僵硬程度是肱动脉僵硬程度回归的重要决定因素（P<0.001），表明肱动脉僵硬程度的回归是对中心主动脉僵硬程度的反应。这些发现表明，在慢性肾脏病进展为晚期之前，传统的心血管危险因素可能在主动脉僵硬的进展中起一定作用，而透析慢性肾脏病患者主动脉僵硬进展速度的增强可能是由更具体的慢性肾脏病相关危险因素决定的，如晚期糖基化终产物。
