Thanakitcharu Prasert, Jitsuparat Yanasar, Jirajan Boonthum
J Med Assoc Thai. 2017 Feb;100 Suppl 1:S56-69.
Patients with chronic kidney disease (CKD), end-stage renal disease (ESRD) with dialysis, and kidney transplant (KT) recipients are associated with increased cardiovascular (CV) morbidity and mortality. Arterial stiffness is a major nontraditional risk factor of CV disease, and increased aortic pulse wave velocity (PWV), the gold standard for arterial stiffness assessment, may predict CV morbidity and mortality in these patients.
The purpose of the present study was to evaluate the prevalence of arterial stiffness in pre-dialysis CKD, ESRD with dialysis patients and KT recipients, and associated factors that exacerbate the condition in order to serve as evidence to search for appropriate therapeutic options.
This was a cross-sectional study of 169 patients including cases of pre-dialysis CKD stages 3-5, ESRD with hemodialysis (HD), continuous ambulatory peritoneal dialysis (CAPD), kidney transplant (KT) recipients and healthy volunteers. Central blood pressure (BP) and aortic PWV were assessed using the SphygmoCor® CPV Pulse Wave Velocity system (AtCor Medical, Sydney, Australia). Increased arterial stiffness was defined as aortic PWV of ≥12 m/s.
The prevalence rates of arterial stiffness in pre-dialysis CKD, HD, CAPD patients, KT recipients and normal controls were 53.1%, 68.8%, 64.7%, 38.9% and 5.7% respectively, and the mean aortic PWVs were 12.7±2.2, 13.5±2.8, 13.4±2.8, 11.3±1.8 and 9.5±1.7 m/s respectively (p<0.001). The factors associated with arterial stiffness determined by univariate analysis were older age, diabetes, CKD, HD, CAPD, KT recipients, higher brachial and central BP, higher serum phosphate, and calcium-phosphate products. A multivariate model showed that only HD, KT recipients, older age and higher central mean arterial pressure (MAP) were independently associated with increased arterial stiffness, with adjusted odds ratio (95% confidence interval) of 17.71 (2.39-131.04), 9.29 (1.46-59.09), 1.09 (1.05-1.14), and 1.11 (1.06-1.16) respectively.
Arterial stiffness was markedly raised in all groups of CKD patients with an overall prevalence of 56%. The highest prevalence of arterial stiffness was found in ESRD patients treated with HD and CAPD. It was shown that the associated factors that independently increased arterial stiffness were HD patients, KT recipients, older age and higher central MAP.
慢性肾脏病（CKD）患者、接受透析的终末期肾病（ESRD）患者以及肾移植（KT）受者的心血管（CV）发病率和死亡率均有所增加。动脉僵硬度是心血管疾病的主要非传统危险因素，而主动脉脉搏波速度（PWV）增加作为动脉僵硬度评估的金标准，可能预测这些患者的心血管发病率和死亡率。
本研究旨在评估透析前CKD患者、接受透析的ESRD患者和KT受者的动脉僵硬度患病率，以及加剧病情的相关因素，以便为寻找合适的治疗方案提供依据。
这是一项横断面研究，纳入了169例患者，包括透析前CKD 3 - 5期患者、接受血液透析（HD）的ESRD患者、持续性非卧床腹膜透析（CAPD）患者、肾移植（KT）受者以及健康志愿者。使用SphygmoCor® CPV脉搏波速度系统（澳大利亚悉尼的AtCor Medical公司）评估中心血压（BP）和主动脉PWV。动脉僵硬度增加定义为主动脉PWV≥12 m/s。
透析前CKD患者、HD患者、CAPD患者、KT受者和正常对照组的动脉僵硬度患病率分别为53.1%、68.8%、64.7%、38.9%和5.7%，平均主动脉PWV分别为12.7±2.2、13.5±2.8、13.4±2.8、11.3±1.8和9.5±1.7 m/s（p<0.001）。单因素分析确定的与动脉僵硬度相关的因素包括年龄较大、糖尿病、CKD、HD、CAPD、KT受者、较高的肱动脉和中心血压、较高的血清磷酸盐以及钙磷乘积。多变量模型显示，只有HD、KT受者、年龄较大和较高的中心平均动脉压（MAP）与动脉僵硬度增加独立相关，调整后的比值比（95%置信区间）分别为17.71（2.39 - 131.04）、9.29（1.46 - 59.09）、1.09（1.05 - 1.14）和1.11（1.06 - 1.16）。
所有CKD患者组的动脉僵硬度均显著升高，总体患病率为56%。接受HD和CAPD治疗的ESRD患者中动脉僵硬度患病率最高。结果表明，独立增加动脉僵硬度的相关因素为HD患者、KT受者、年龄较大和较高的中心MAP。
