Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom.
Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Department of Nephrology, Queen Elizabeth Hospital, Birmingham, United Kingdom.
Int J Cardiol. 2020 Dec 1;320:141-147. doi: 10.1016/j.ijcard.2020.08.013. Epub 2020 Aug 14.
Coronary microvascular dysfunction is prevalent in chronic kidney disease (CKD), and may contribute to the development of myocardial dysfunction in CKD. Coronary flow velocity reserve (CFVR) is a marker of coronary microvascular function and falls with increasing CKD stage. Living kidney donors have renal function consistent with early stage CKD and concern has been raised about their cardiovascular risk. No studies to date have investigated the presence of coronary microvascular dysfunction in living kidney donors.
25 healthy controls and 23 living kidney donors were recruited and underwent assessment with transthoracic echocardiography, Doppler CFVR, myocardial contrast echocardiography and serum multiplex immunoassay panels.
Doppler CFVR was significantly reduced in living kidney donors compared to controls (mean CFVR 3.4 ± 0.7 vs 3.8 ± 0.6, mean difference 0.4 95% confidence interval 0.03-0.8, p =.036). Quantitative myocardial contrast echocardiography showed a trend towards reduced coronary flow reserve in living kidney donors. Compared to controls, living kidney donors had higher serum high sensitivity C reactive peptide (hsCRP) and lower levels of uromodulin.
This is the first study of CFVR in living kidney donors. We have shown that the modest drop in estimated glomerular filtration rate in living kidney donors is associated with lower values of Doppler CFVR compared to controls, suggesting that isolated reductions in renal function may lead to altered microvascular function. The increase in hsCRP and reduction in uromodulin suggests that chronic subclinical inflammation may contribute to altered microvascular function in this population.
冠状动脉微血管功能障碍在慢性肾脏病（CKD）中很常见，可能导致 CKD 中心肌功能障碍的发展。冠状动脉血流储备（CFVR）是冠状动脉微血管功能的标志物，随着 CKD 分期的增加而降低。活体供肾者的肾功能与早期 CKD 一致，人们对其心血管风险表示担忧。迄今为止，尚无研究调查活体供肾者是否存在冠状动脉微血管功能障碍。
招募了 25 名健康对照者和 23 名活体供肾者，并对其进行经胸超声心动图、多普勒 CFVR、心肌对比超声心动图和血清多重免疫分析面板评估。
与对照组相比，活体供肾者的多普勒 CFVR 明显降低（平均 CFVR 3.4±0.7 对 3.8±0.6，平均差异 0.4，95%置信区间 0.03-0.8，p=0.036）。定量心肌对比超声心动图显示活体供肾者的冠状动脉血流储备呈下降趋势。与对照组相比，活体供肾者的血清高敏 C 反应蛋白（hsCRP）水平较高，尿调蛋白水平较低。
这是活体供肾者 CFVR 的首次研究。我们发现，活体供肾者的估计肾小球滤过率略有下降，与对照组相比，多普勒 CFVR 值较低，这表明孤立的肾功能下降可能导致微血管功能改变。hsCRP 的增加和尿调蛋白的减少提示，慢性亚临床炎症可能导致该人群微血管功能改变。
