Arterial Stiffness in the Heart Disease of CKD

CKD frequently leads to chronic cardiac dysfunction. This complex relationship has been termed as cardiorenal syndrome type 4 or cardio-renal link. Despite numerous studies and reviews focused on the pathophysiology and therapy of this syndrome, the role of arterial stiffness has been frequently ove...

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Bibliographic Details
Published in:Journal of the American Society of Nephrology Vol. 30; no. 6; p. 918
Main Authors: Zanoli, Luca, Lentini, Paolo, Briet, Marie, Castellino, Pietro, House, Andrew A, London, Gerard M, Malatino, Lorenzo, McCullough, Peter A, Mikhailidis, Dimitri P, Boutouyrie, Pierre
Format: Journal Article
Language:English
Published: United States 01.06.2019
Subjects:
Age Distribution
Aged
Cardio-Renal Syndrome - epidemiology
Cardio-Renal Syndrome - physiopathology
Cardiotonic Agents - therapeutic use
Cardiovascular Diseases - drug therapy
Cardiovascular Diseases - epidemiology
Cardiovascular Diseases - physiopathology
Cause of Death
Comorbidity
Female
Humans
Male
Middle Aged
Prevalence
Prognosis
Renal Dialysis - methods
Renal Insufficiency, Chronic - epidemiology
Renal Insufficiency, Chronic - physiopathology
Renal Insufficiency, Chronic - therapy
Risk Assessment
Severity of Illness Index
Sex Distribution
Survival Analysis
Vascular Stiffness - drug effects
Vascular Stiffness - physiology
arteries, cardiovascular disease, chronic kidney disease, Chronic inflammation, arteriosclerosis, pulse wave velocity
ISSN:1533-3450, 1533-3450
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Summary:CKD frequently leads to chronic cardiac dysfunction. This complex relationship has been termed as cardiorenal syndrome type 4 or cardio-renal link. Despite numerous studies and reviews focused on the pathophysiology and therapy of this syndrome, the role of arterial stiffness has been frequently overlooked. In this regard, several pathogenic factors, including uremic toxins ( , uric acid, phosphates, endothelin-1, advanced glycation end-products, and asymmetric dimethylarginine), can be involved. Their effect on the arterial wall, direct or mediated by chronic inflammation and oxidative stress, results in arterial stiffening and decreased vascular compliance. The increase in aortic stiffness results in increased cardiac workload and reduced coronary artery perfusion pressure that, in turn, may lead to microvascular cardiac ischemia. Conversely, reduced arterial stiffness has been associated with increased survival. Several approaches can be considered to reduce vascular stiffness and improve vascular function in patients with CKD. This review primarily discusses current understanding of the mechanisms concerning uremic toxins, arterial stiffening, and impaired cardiac function, and the therapeutic options to reduce arterial stiffness in patients with CKD.
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ISSN:1533-3450
1533-3450
DOI:10.1681/ASN.2019020117