Department of Clinical and Experimental Medicine, School of Nephrology, University of Catania, Catania, Italy.
Department of Pharmacology, INSERM U970.
J Hypertens. 2019 Jun;37(6):1176-1182. doi: 10.1097/HJH.0000000000002007.
Increased carotid stiffness and remodelling is reported in patients with moderate and advanced chronic kidney disease (CKD) and is associated with cardiovascular events. Here, we tested the hypothesis that carotid artery alterations start earlier, during mild CKD.
Within the Paris Prospective Study 3, a large prospective observational survey of nonreferred people aged 50-75 who received an extensive health check-up, there were 294 participants with glomerular filtration rate (GFR) of at least 45 and less than 60 ml/min per 1.73 m (Stage 3A CKD), 840 participants with GFR 60-89 ml/min per 1.73 m with proteinuria (Stage 2 CKD), 4666 participants with GFR 60-89 ml/min per 1.73 m without proteinuria and 3317 individuals with GFR at least 90 ml/min per 1.73 m at study recruitment. Carotid artery measurements were performed using a high-resolution echotracking device.
Compared with patients with GFR at least 90 ml/min per 1.73 m, the carotid distensibility and strain progressively decreased (P for trend <0.0001), whereas carotid stiffness progressively increased (P for trend <0.0001) across GFR categories starting at early stage from GFR 60-89 ml/min per 1.73 m without proteinuria. Higher Young's elastic modulus was observed only for Stage 3A CKD, whereas carotid internal diastolic diameter did not differ between groups.
The large arterial stiffening starts early during CKD, even in participants with a very mild reduction in renal function.
据报道，中重度和进展性慢性肾脏病（CKD）患者的颈动脉僵硬度和重塑增加，并与心血管事件相关。在此，我们检验了一个假设，即颈动脉的改变在轻度 CKD 时就已经开始了。
在巴黎前瞻性研究 3 中，对年龄在 50-75 岁之间、未接受转诊的非患者进行了一项大型前瞻性观察性调查，参与者接受了广泛的健康检查。在这些参与者中，有 294 名肾小球滤过率（GFR）至少为 45 但小于 60ml/min/1.73m（3A 期 CKD），840 名 GFR 为 60-89ml/min/1.73m 且有蛋白尿（2 期 CKD），4666 名 GFR 为 60-89ml/min/1.73m 且无蛋白尿，3317 名 GFR 至少为 90ml/min/1.73m。使用高分辨率超声心动图设备进行颈动脉测量。
与 GFR 至少为 90ml/min/1.73m 的患者相比，颈动脉可扩张性和应变逐渐降低（趋势 P<0.0001），而颈动脉僵硬度则从 GFR 为 60-89ml/min/1.73m 且无蛋白尿的早期阶段开始逐渐增加（趋势 P<0.0001）。仅在 3A 期 CKD 中观察到较高的杨氏弹性模量，而颈动脉内舒张直径在各组之间无差异。
即使在肾功能轻度下降的患者中，CKD 也会很早就出现大动脉僵硬。
