Chong Karen C, Owens Christopher D, Park Meyeon, Alley Hugh F, Boscardin W John, Conte Michael S, Gasper Warren J, Grenon S Marlene
Division of Vascular and Endovascular Surgery, University of California, San Francisco, Calif; VIPERx Laboratory, University of California, San Francisco, Calif.
Division of Vascular and Endovascular Surgery, University of California, San Francisco, Calif; VIPERx Laboratory, University of California, San Francisco, Calif; Division of Vascular Surgery, Veterans Affairs Medical Center, San Francisco, Calif.
J Vasc Surg. 2014 Dec;60(6):1605-11. doi: 10.1016/j.jvs.2014.08.105. Epub 2014 Oct 16.
We have previously shown that peripheral artery disease (PAD) is associated with marked impairment of endothelial function (EF). Given that poor EF is associated with functional status of PAD patients as well as with increased morbidity and mortality in patients undergoing vascular procedures, determination of factors associated with poor EF in a PAD cohort is important. We hypothesized that decreased kidney function is associated with impaired EF in patients with PAD.
This was a cross-sectional study of PAD patients presenting to a vascular surgery outpatient clinic at the San Francisco Veterans Affairs Medical Center including patients enrolled in the OMEGA-PAD I trial (NCT01310270) and the OMEGA-PAD Cohort. Brachial artery flow-mediated vasodilation was performed to assess EF. Kidney function was characterized by estimated glomerular filtration rate with the abbreviated Modification of Diet in Renal Disease formula. Linear regression was performed to assess the relationship between EF and kidney function in claudicants.
Ninety-seven patients with intermittent claudication participated in this study. Mean age was 69 ± 8 years, 97% were male, and 79% were white. Comorbidities included hypertension (91%), dyslipidemia (87%), coronary artery disease (42%), and diabetes mellitus (38%). Mean ankle-brachial index was 0.73 ± 0.14 and mean flow-mediated vasodilation was 7.0% ± 3.8%, indicating impaired EF. Linear regression showed an association between kidney function and EF (by 10 mL/min/1.73 m(2); β, 0.12; confidence interval, 0.05-0.20; P = .001). After multivariable regression adjusting for age, race, log tumor necrosis factor α, hypertension, dyslipidemia, and diabetes, estimated glomerular filtration rate remained significantly associated with EF (P = .033).
In patients with PAD, decreased kidney function is associated with endothelial dysfunction. Further longitudinal studies are needed to better understand the impact of kidney function on PAD progression and the role of endothelial dysfunction in this process.
我们之前已经表明外周动脉疾病（PAD）与内皮功能（EF）的显著受损有关。鉴于EF不佳与PAD患者的功能状态以及血管手术患者的发病率和死亡率增加相关，确定PAD队列中与EF不佳相关的因素很重要。我们假设肾功能下降与PAD患者的EF受损有关。
这是一项对在旧金山退伍军人事务医疗中心血管外科门诊就诊的PAD患者进行的横断面研究，包括参加OMEGA-PAD I试验（NCT01310270）和OMEGA-PAD队列的患者。通过肱动脉血流介导的血管舒张来评估EF。肾功能通过使用简化的肾脏疾病饮食改良公式估算的肾小球滤过率来表征。进行线性回归以评估跛行患者中EF与肾功能之间的关系。
97例间歇性跛行患者参与了本研究。平均年龄为69±8岁，97%为男性，79%为白人。合并症包括高血压（91%）、血脂异常（87%）、冠状动脉疾病（42%）和糖尿病（38%）。平均踝臂指数为0.73±0.14，平均血流介导的血管舒张为7.0%±3.8%，表明EF受损。线性回归显示肾功能与EF之间存在关联（每10 mL/min/1.73 m²；β，0.12；置信区间，0.05 - 0.20；P = 0.001）。在对年龄、种族、对数肿瘤坏死因子α、高血压、血脂异常和糖尿病进行多变量回归调整后，估算的肾小球滤过率仍与EF显著相关（P = 0.033）。
在PAD患者中，肾功能下降与内皮功能障碍有关。需要进一步的纵向研究来更好地理解肾功能对PAD进展的影响以及内皮功能障碍在此过程中的作用。
