Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.
Nephron. 2022;146(1):11-21. doi: 10.1159/000518174. Epub 2021 Sep 6.
Unfavorable changes in cardiac and arterial function are related to poor prognosis in chronic kidney disease (CKD). We compared hemodynamic profiles between subjects with end-stage renal disease and 2 control groups with corresponding pulse wave velocities (PWVs).
Noninvasive hemodynamics were recorded during passive head-up tilt in CKD stage 5 patients (n = 35), patients with primary hypertension (n = 35, n = 30 with antihypertensive medications), and subjects without cardiovascular or renal diseases and cardiovascular medications (n = 70). The groups were selected to have corresponding age, sex, body mass index, and PWV. Hemodynamic data were captured using whole-body impedance cardiography and radial tonometric pulse wave analysis.
Supine blood pressure did not differ between the groups, but upright diastolic blood pressure was lower in CKD patients than in the 2 control groups (p ≤ 0.001 for both, RANOVA). Despite similar PWV, supine aortic pulse pressure was higher in CKD patients versus nonmedicated subjects (p = 0.029). Two additional measures indicated reduced aortic compliance in CKD patients versus both control groups: lower ratio of stroke index to aortic pulse pressure (p ≤ 0.023) and higher aortic characteristic impedance (p ≤ 0.003). The subendocardial viability ratio was lower in the CKD group than in both control groups (p ≤ 0.039).
In the absence of differences in PWV, higher aortic pulse pressure and characteristic impedance, and lower ratio of stroke index to aortic pulse pressure, suggest reduced aortic compliance and impaired left ventricular function in CKD patients. A lower subendocardial viability ratio predisposes the CKD patients to impaired cardiac oxygen supply versus hypertensive patients and nonmedicated controls.
心脏和动脉功能的不利变化与慢性肾脏病（CKD）的预后不良有关。我们比较了终末期肾病患者与 2 个具有相应脉搏波速度（PWV）的对照组之间的血流动力学特征。
在 CKD 5 期患者（n = 35）、原发性高血压患者（n = 35，其中 30 名患者服用降压药物）和无心血管或肾脏疾病且未服用心血管药物的受试者（n = 70）进行被动仰卧位倾斜时，记录非侵入性血流动力学。选择这些组的目的是使它们具有相应的年龄、性别、体重指数和 PWV。使用全身阻抗心动图和桡动脉测压脉搏波分析来获取血流动力学数据。
仰卧位血压在各组之间没有差异，但直立舒张压在 CKD 患者中低于 2 个对照组（均 p ≤ 0.001，随机区组方差分析）。尽管 PWV 相似，但 CKD 患者的仰卧位主动脉脉搏压高于未服用药物的受试者（p = 0.029）。另外两个指标表明 CKD 患者的主动脉顺应性降低：每搏指数与主动脉脉搏压的比值较低（p ≤ 0.023），主动脉特征阻抗较高（p ≤ 0.003）。与两个对照组相比，CKD 组的心肌内活力比降低（p ≤ 0.039）。
在 PWV 无差异的情况下，主动脉脉搏压和特征阻抗较高，每搏指数与主动脉脉搏压的比值较低，提示 CKD 患者的主动脉顺应性降低，左心室功能受损。心肌内活力比降低使 CKD 患者的心肌供氧受损的风险高于高血压患者和未服用药物的对照组。
