Department of Nephrology, General Hospital of Ptolemaida, Ptolemaida, Greece.
Department of Informatics and Telecommunications Engineering, University of Western Macedonia, Kozani, Greece.
J Clin Hypertens (Greenwich). 2018 Sep;20(9):1276-1284. doi: 10.1111/jch.13350. Epub 2018 Jul 14.
In the general population aortic stiffening, assessed by carotid femoral pulse wave velocity (cf-PWV), is associated with cognitive dysfunction (CO/DY). Data in chronic kidney disease (CKD) are limited. This study tests the hypothesis that large artery stiffness and microvascular damage in CKD patients are related to the damage of brain microcirculation reflected by impaired cognitive function. A cross-sectional study enrolled 151 patients (mean age 58.4 years; 64.5% males; 44 patients with CKD stage 1; 47 with stage 2; 25 with stage 3; and 35 with stage 4). Cognitive impairment, assessed by the Mini Mental State Examination (MMSE), the Clock - drawing test (Clock-test), and the Instrumental Activity of Daily Living (IADL), was considered as primary outcome. We measured systolic and pulse pressures at the brachial and aortic sites and cf-PWV. Our patients revealed a significant linear deterioration in all the domains of cognitive function according to CKD stages. High values of cf-PWV (P = 0.029) and aortic pulse pressure (aPP) (P < 0.026) were independent determinants of cognitive decline assessed by the MMSE. The present trial supports the hypothesis of an interaction between the kidney, large artery damage, central pressure pulsatility, and the injury of brain microcirculation. In clinical practice, cf-PWV and aPP measurements may help to predict cognitive decline. Whether the reduction in aortic stiffness following an aggressive treatment translates into improved cognitive outcomes remains to be determined.
在普通人群中，通过颈股脉搏波速度（cf-PWV）评估的主动脉僵硬度与认知功能障碍（CO/DY）相关。在慢性肾脏病（CKD）中的数据有限。本研究检验了一个假设，即 CKD 患者的大动脉僵硬和微血管损伤与脑微循环损伤有关，这种损伤反映在认知功能受损上。一项横断面研究纳入了 151 名患者（平均年龄 58.4 岁；64.5%为男性；44 名患者为 CKD 1 期；47 名患者为 2 期；25 名患者为 3 期；35 名患者为 4 期）。认知障碍通过简易精神状态检查（MMSE）、画钟测验（Clock-test）和日常生活活动能力量表（IADL）评估，被认为是主要结局。我们测量了肱动脉和主动脉部位的收缩压和脉压以及 cf-PWV。我们的患者根据 CKD 分期，在所有认知功能领域都出现了显著的线性恶化。cf-PWV（P=0.029）和主动脉脉搏压（aPP）（P<0.026）的高值是 MMSE 评估的认知下降的独立决定因素。本试验支持了肾脏、大动脉损伤、中心压力搏动性和脑微循环损伤之间相互作用的假设。在临床实践中，cf-PWV 和 aPP 的测量可能有助于预测认知下降。积极治疗后主动脉僵硬度的降低是否能转化为认知功能的改善，还有待确定。
