Tomiyama Hirofumi, Yamashina Akira
Department of Cardiology, Tokyo Medical University, Tokyo, Japan.
Pulse (Basel). 2014 May;2(1-4):81-94. doi: 10.1159/000374092. Epub 2015 Feb 27.
Chronic kidney disease (CKD) is an independent risk factor for cardiovascular disease. Recently, noninvasive and simple morphological and functional methods have been introduced to assess atherosclerotic vascular damage. This review describes the association of CKD with vascular damage as assessed by these methods. Carotid intima-media thickness (IMT) and coronary artery calcium score (CACS) are morphological parameters of vascular damage, and an ankle-brachial index (ABI) <0.90 suggests the presence of peripheral arterial disease (i.e., it represents advanced atherosclerosis). Several prospective studies have demonstrated that CKD is a risk factor for an increased IMT, an increased CACS and a decreased ABI. While it has not been clarified whether measuring the IMT or CACS might be useful to predict the progression of renal function decline, a reduced ABI has been demonstrated as a predictor of accelerated renal function decline. On the other hand, pulse wave velocity (PWV) is a marker of arterial stiffness rather than atherosclerosis, reflecting functional abnormalities caused by vascular damage, and moderate-to-severe CKD may be a risk factor for the progression of arterial stiffness. The measurement of functional markers, especially of PWV or pulse pressure, has been demonstrated to be useful to predict the rate of progression of renal function decline. Thus, renal dysfunction and atherogenic states may be components of a vicious cycle, and vascular function abnormalities associated with atherosclerosis may accelerate this cycle. As the next step, we propose to examine whether improvement of vascular function abnormalities can interrupt this vicious cycle.
慢性肾脏病（CKD）是心血管疾病的独立危险因素。近来，已引入非侵入性且简单的形态学和功能学方法来评估动脉粥样硬化性血管损伤。本综述描述了通过这些方法评估的CKD与血管损伤之间的关联。颈动脉内膜中层厚度（IMT）和冠状动脉钙化积分（CACS）是血管损伤的形态学参数，踝臂指数（ABI）<0.90提示存在外周动脉疾病（即，它代表晚期动脉粥样硬化）。多项前瞻性研究表明，CKD是IMT增加、CACS增加及ABI降低的危险因素。虽然尚未明确测量IMT或CACS是否有助于预测肾功能下降的进展，但已证明ABI降低是肾功能加速下降的预测指标。另一方面，脉搏波速度（PWV）是动脉僵硬度而非动脉粥样硬化的标志物，反映血管损伤引起的功能异常，中重度CKD可能是动脉僵硬度进展的危险因素。已证明测量功能标志物，尤其是PWV或脉压，有助于预测肾功能下降的进展速度。因此，肾功能不全和致动脉粥样硬化状态可能是恶性循环的组成部分，与动脉粥样硬化相关的血管功能异常可能会加速这一循环。作为下一步，我们建议研究血管功能异常的改善是否能中断这一恶性循环。
