Hsu Hon-Chun, Mazibuko Makabongwe S'kholiwe, Robinson Chanel, Dlongolo Noluntu, Woodiwiss Angela, Teckie Gloria, Tade Grace, Dessein Patrick Hector
Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa.
Nephrology Unit, Milpark Hospital, Johannesburg 2193, South Africa.
J Clin Med. 2024 Dec 21;13(24):7827. doi: 10.3390/jcm13247827.
The study aimed to assess the potential impacts of mean arterial pressure (MAP) and its determinants (cardiac output and systemic vascular resistance) on diabetic nephropathy (DNP)-associated impaired aortic function. This multi-ethnic study included 115 chronic kidney disease (CKD) patients (67 non-dialysis and 48 dialysis). Six aortic function measures were evaluated by SpygmoCor. The stroke volume was determined by echocardiography. Hypertensive nephropathy (HNP) (53.9%), DNP (32.2%), glomerulonephritis (19.1%), and HIV-associated nephropathy (7.8%) composed the major CKD etiologies. Concurrent HNP and DNP were present in 31.1% of the patients. Participants with compared with those without concurrent HNP and DNP experienced more frequent established cardiovascular disease (43.2% versus 14.9%, = 0.01), a faster pulse wave velocity ( = 0.001), and smaller total arterial compliance as an indicator of proximal aortic stiffness ( = 0.03). DNP was associated with each aortic function measure ( < 0.001-0.02) independent of potential confounders and MAP, as well as its determinants. HNP was not related to aortic function ( > 0.05 for all relationships). MAP and its determinants did not mediate the potential impact of DNP on aortic function (-4.1-6.4% contribution). Covariates that were associated with impaired aortic function measures included MAP and its determinants ( < 0.001-0.01). Mean or distending arterial pressure and its determinants were associated with impaired aortic function in the overall CKD population. However, these hemodynamic factors did not mediate DNP-associated impaired aortic function. Our results suggest that blood pressure lowering can be anticipated to improve impaired aortic function in the overall CKD population but not when it is solely induced by DNP.
该研究旨在评估平均动脉压（MAP）及其决定因素（心输出量和全身血管阻力）对糖尿病肾病（DNP）相关的主动脉功能受损的潜在影响。这项多民族研究纳入了115例慢性肾脏病（CKD）患者（67例非透析患者和48例透析患者）。通过SphygmoCor评估六项主动脉功能指标。通过超声心动图测定每搏输出量。高血压肾病（HNP）（53.9%）、DNP（32.2%）、肾小球肾炎（19.1%）和HIV相关性肾病（7.8%）构成了主要的CKD病因。31.1%的患者同时存在HNP和DNP。与未同时患有HNP和DNP的参与者相比，同时患有HNP和DNP的参与者发生心血管疾病的频率更高（43.2%对14.9%，P = 0.01），脉搏波速度更快（P = 0.001），作为近端主动脉僵硬度指标的总动脉顺应性更小（P = 0.03）。独立于潜在混杂因素、MAP及其决定因素，DNP与每项主动脉功能指标相关（P < 0.001 - 0.02）。HNP与主动脉功能无关（所有关系的P > 0.05）。MAP及其决定因素并未介导DNP对主动脉功能的潜在影响（贡献为 - 4.1 - 6.4%）。与主动脉功能受损指标相关的协变量包括MAP及其决定因素（P < 0.001 - 0.01）。平均动脉压或扩张动脉压及其决定因素与整个CKD人群的主动脉功能受损相关。然而，这些血流动力学因素并未介导DNP相关的主动脉功能受损。我们的结果表明，预计降低血压可改善整个CKD人群的主动脉功能受损，但仅由DNP引起时则不然。
