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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| Veröffentlicht in: | Journal of the American Society of Nephrology Jg. 30; H. 6; S. 918 |
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| Abstract | 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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| AbstractList | 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. 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 (i.e., 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.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 (i.e., 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. |
| Author | Zanoli, Luca McCullough, Peter A Castellino, Pietro London, Gerard M Mikhailidis, Dimitri P Malatino, Lorenzo Lentini, Paolo Briet, Marie House, Andrew A Boutouyrie, Pierre |
| Author_xml | – sequence: 1 givenname: Luca surname: Zanoli fullname: Zanoli, Luca email: zanoli.rastelli@gmail.com organization: Sections of Nephrology and zanoli.rastelli@gmail.com – sequence: 2 givenname: Paolo surname: Lentini fullname: Lentini, Paolo organization: Division of Nephrology and Dialysis, St. Bassiano Hospital, Bassano del Grappa, Italy – sequence: 3 givenname: Marie surname: Briet fullname: Briet, Marie organization: Institut National de la Santé et de la Recherche Médicale U1083, National Center for Scientific Research Joint Research Unit 6214, Centre Hospitalo-Universitaire d'Angers, Université d'Angers, Angers, France – sequence: 4 givenname: Pietro surname: Castellino fullname: Castellino, Pietro organization: Internal Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy – sequence: 5 givenname: Andrew A surname: House fullname: House, Andrew A organization: Department of Medicine, University of Western Ontario, London, Ontario, Canada – sequence: 6 givenname: Gerard M surname: London fullname: London, Gerard M organization: Institut National de la Santé et de la Recherche Médicale U970, Paris, France – sequence: 7 givenname: Lorenzo surname: Malatino fullname: Malatino, Lorenzo organization: Internal Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy – sequence: 8 givenname: Peter A surname: McCullough fullname: McCullough, Peter A organization: Department of Medicine, Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas – sequence: 9 givenname: Dimitri P surname: Mikhailidis fullname: Mikhailidis, Dimitri P organization: Department of Clinical Biochemistry, University College London, London, UK – sequence: 10 givenname: Pierre surname: Boutouyrie fullname: Boutouyrie, Pierre organization: Department of Pharmacology, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31040188$$D View this record in MEDLINE/PubMed |
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| Snippet | CKD frequently leads to chronic cardiac dysfunction. This complex relationship has been termed as cardiorenal syndrome type 4 or cardio-renal link. Despite... |
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| SubjectTerms | 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 |
| Title | Arterial Stiffness in the Heart Disease of CKD |
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