Department of Nephrology, Command Hospital Air Force, Bengaluru, Karnataka, India.
Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India.
Saudi J Kidney Dis Transpl. 2021 May-Jun;32(3):657-670. doi: 10.4103/1319-2442.336760.
Cardiovascular diseases are an important cause of mortality in end-stage renal disease (ESRD) and increased arterial stiffness and autonomic dysfunction have been proposed to explain part of this excess cardiovascular risk. This prospective study was designed with the aim of noninvasive assessment of the vascular function, i.e., arterial stiffness in the form of pulse wave velocity (PWV) and autonomic function in the form of baroreflex sensitivity (BRS) in ESRD patients before renal transplantation (RT) and three and six months after RT. The study was conducted in 64 patients of ESRD slated for RT in the Department of Nephrology and was being followed up during all three visits (pretransplant, three-, and six-month posttransplant). The period of patient recruitment and data collection lasted for approximately 1½ years. Although PWV did not show a significant change, the change in PWV was negatively correlated with baseline PWV, and it was statistically significant. The BRS after RT had a significant improvement as early as three months. The correlation between change in PWV and change in BRS postrenal transplant was not seen. RT improves BRS, but it is still unknown that it is through amelioration of arterial properties or neural components or/and a relative contribution of both. We suggest that the improvement in BRS postrenal transplant is probably because of the improvement in autonomic neural functions rather than the improvement in compliance of barosensitive regions of large arteries.
心血管疾病是终末期肾病（ESRD）患者死亡的一个重要原因，并且已经提出动脉僵硬和自主神经功能障碍增加部分解释了这种过度的心血管风险。本前瞻性研究旨在非侵入性评估血管功能，即在肾移植（RT）前和 RT 后 3 个月和 6 个月时以脉搏波速度（PWV）的形式评估动脉僵硬和以压力反射敏感性（BRS）的形式评估自主神经功能，研究对象为肾脏病科拟行 RT 的 64 例 ESRD 患者，并在所有 3 次就诊时（移植前、移植后 3 个月和 6 个月）进行随访。患者招募和数据收集期持续了大约 1 年半。尽管 PWV 没有显著变化，但 PWV 的变化与基线 PWV 呈负相关，且具有统计学意义。RT 后 BRS 早在 3 个月就有显著改善。移植后 PWV 变化与 BRS 变化之间没有相关性。RT 改善了 BRS，但尚不清楚是通过改善动脉特性还是神经成分或两者的相对贡献来实现的。我们认为，移植后 BRS 的改善可能是由于自主神经功能的改善，而不是大动脉压力敏感区顺应性的改善。
