Juan Carlos Hidalgo Santiago , Jary Perelló Martínez , Javier Vargas Romero , José Luis Pallares , Alfredo Michan Doña , Pablo Gómez-Fernández
{"title":"Asociación de la rigidez aórtica con calcificaciones vasculares abdominales y coronarias en pacientes con enfermedad renal crónica estadios 3 y 4","authors":"Juan Carlos Hidalgo Santiago , Jary Perelló Martínez , Javier Vargas Romero , José Luis Pallares , Alfredo Michan Doña , Pablo Gómez-Fernández","doi":"10.1016/j.nefro.2023.06.002","DOIUrl":null,"url":null,"abstract":"<div><h3>Rationale and objectives</h3><p>Increased central (aortic) arterial stiffness has hemodynamic repercussions that affect the incidence of cardiovascular and renal disease. In chronic kidney disease (CKD) there may be an increase in aortic stiffness secondary to multiple metabolic alterations including calcification of the vascular wall (VC).</p><p>The objective of this study was to analyze the association of central aortic pressures and aortic stiffness with the presence of VC in abdominal aorta (AAC) and coronary arteries (CAC).</p></div><div><h3>Materials and methods</h3><p>We included 87 patients with CKD stage 3 and 4. Using applanation tonometry, central aortic pressures and aortic stiffness were studied. We investigated the association of aortic pulse wave velocity (Pv<sub>c-f</sub>) and Pv<sub>c-f</sub> adjusted for age, blood pressure, sex and heart rate (Pv<sub>c-f</sub> index) with AAC obtained on lumbar lateral radiography and CAC assessed by multidetector computed tomography. AAC and CAC were scored according to Kauppila and Agatston methods, respectively. For the study of the association between iPv<sub>c-f</sub> index, Kauppila score, Agatston score, central aortic pressures, clinical parameters and laboratory data, multiple and logistic regression were used. We investigated the diagnosis performance of the Pv<sub>c-f</sub> index for prediction of VC using receiver-operating characteristic (ROC).</p></div><div><h3>Results</h3><p>Pv<sub>c-f</sub> and Pv<sub>c-f</sub> index were 11.3<!--> <!-->±<!--> <!-->2.6<!--> <!-->m/s and 10.6<!--> <!-->m/s, respectively. The Pv<sub>c-f</sub> index was higher when CKD coexisted with diabetes mellitus (DM). AAC and CAC were detected in 77% and 87%, respectively.</p><p>Albuminuria (<em>β</em> <span>=</span> <!-->0.13, <em>p</em> <span>=</span> <!-->0.005) and Kauppila score (<em>β</em> <span>=</span> <!-->0.36, <em>p</em> <span>=</span> <!-->0.001) were independently associated with Pv<sub>c-f</sub> index. In turn, Pv<sub>c-f</sub> index (<em>β</em> <span>=</span> <!-->0.39, <em>p</em> <span>=</span> <!-->0.001), DM (<em>β</em> <span>=</span> <!-->0.46, <em>p</em> <span>=</span> <!-->0.01), and smoking (<em>β</em> <span>=</span> <!-->0.53; <em>p</em> <span>=</span> <!-->0.006) were associated with Kauppila score, but only Pv<sub>c-f</sub> index predicted AAC [OR: 3.33 (95% CI: 1.6–6.9; <em>p</em> <span>=</span> <!-->0.001)].</p><p>The Kauppila score was independently associated with the Agatston score (<em>β</em> <span>=</span> <!-->1.53, <em>p</em> <span>=</span> <!-->0.001). The presence of AAC identified patients with CAC with a sensitivity of 73%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 38%.</p><p>The Vp<sub>c-f</sub> index predicted the presence of CAC [OR: 3.35 (95% CI: 1.04–10.2, <em>p</em> <span>=</span> <!-->0.04)]. In the ROC curves, using the Vp<sub>c-f</sub> index, the AUC for AAC and CAC was 0.82 (95% CI: 0.71–0.93, <em>p</em> <span>=</span> <!-->0.001) and 0.81 (95% CI: 0.67–0.96, <em>p</em> <span>=</span> <!-->0.02), respectively.</p></div><div><h3>Conclusions</h3><p>When stage 3–4 CKD coexists with DM there is an increase in aortic stiffness determined by the Vp<sub>c-f</sub> index. In stage 3–4 CKD, AAC and CAC are very prevalent and both often coexist. The Vp<sub>c-f</sub> index is independently associated with AAC and CAC and may be useful in identifying patients with VC in these territories.</p></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":null,"pages":null},"PeriodicalIF":2.0000,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699523000942/pdfft?md5=8422146c50f5a11e6702ae664ff150ed&pid=1-s2.0-S0211699523000942-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Nefrologia","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0211699523000942","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Rationale and objectives
Increased central (aortic) arterial stiffness has hemodynamic repercussions that affect the incidence of cardiovascular and renal disease. In chronic kidney disease (CKD) there may be an increase in aortic stiffness secondary to multiple metabolic alterations including calcification of the vascular wall (VC).
The objective of this study was to analyze the association of central aortic pressures and aortic stiffness with the presence of VC in abdominal aorta (AAC) and coronary arteries (CAC).
Materials and methods
We included 87 patients with CKD stage 3 and 4. Using applanation tonometry, central aortic pressures and aortic stiffness were studied. We investigated the association of aortic pulse wave velocity (Pvc-f) and Pvc-f adjusted for age, blood pressure, sex and heart rate (Pvc-f index) with AAC obtained on lumbar lateral radiography and CAC assessed by multidetector computed tomography. AAC and CAC were scored according to Kauppila and Agatston methods, respectively. For the study of the association between iPvc-f index, Kauppila score, Agatston score, central aortic pressures, clinical parameters and laboratory data, multiple and logistic regression were used. We investigated the diagnosis performance of the Pvc-f index for prediction of VC using receiver-operating characteristic (ROC).
Results
Pvc-f and Pvc-f index were 11.3 ± 2.6 m/s and 10.6 m/s, respectively. The Pvc-f index was higher when CKD coexisted with diabetes mellitus (DM). AAC and CAC were detected in 77% and 87%, respectively.
Albuminuria (β= 0.13, p= 0.005) and Kauppila score (β= 0.36, p= 0.001) were independently associated with Pvc-f index. In turn, Pvc-f index (β= 0.39, p= 0.001), DM (β= 0.46, p= 0.01), and smoking (β= 0.53; p= 0.006) were associated with Kauppila score, but only Pvc-f index predicted AAC [OR: 3.33 (95% CI: 1.6–6.9; p= 0.001)].
The Kauppila score was independently associated with the Agatston score (β= 1.53, p= 0.001). The presence of AAC identified patients with CAC with a sensitivity of 73%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 38%.
The Vpc-f index predicted the presence of CAC [OR: 3.35 (95% CI: 1.04–10.2, p= 0.04)]. In the ROC curves, using the Vpc-f index, the AUC for AAC and CAC was 0.82 (95% CI: 0.71–0.93, p= 0.001) and 0.81 (95% CI: 0.67–0.96, p= 0.02), respectively.
Conclusions
When stage 3–4 CKD coexists with DM there is an increase in aortic stiffness determined by the Vpc-f index. In stage 3–4 CKD, AAC and CAC are very prevalent and both often coexist. The Vpc-f index is independently associated with AAC and CAC and may be useful in identifying patients with VC in these territories.
期刊介绍:
Nefrología is the official publication of the Spanish Society of Nephrology. The Journal publishes articles on basic or clinical research relating to nephrology, arterial hypertension, dialysis and kidney transplants. It is governed by the peer review system and all original papers are subject to internal assessment and external reviews. The journal accepts submissions of articles in English and in Spanish languages.