Microvascular endothelial dysfunction is associated with albuminuria and CKD in older adults

Background Impairment in glomerular endothelial function likely plays a major role in the development of albuminuria and CKD progression. Glomerular endothelial dysfunction may reflect systemic microvascular dysfunction, accounting in part for the greater cardiovascular risk in patients with albumin...

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Bibliographic Details
Published in:BMC nephrology Vol. 17; no. 1; p. 82
Main Authors: Seliger, Stephen L., Salimi, Shabnam, Pierre, Valerie, Giffuni, Jamie, Katzel, Leslie, Parsa, Afshin
Format: Journal Article
Language:English
Published: London BioMed Central 13.07.2016
BioMed Central Ltd
Springer Nature B.V
Subjects:
Acute coronary syndromes
Aged
Albuminuria
Albuminuria - diagnosis
Albuminuria - epidemiology
Albuminuria - physiopathology
Analysis
Blood Flow Velocity - physiology
Blood pressure
Cardiovascular disease
Care and treatment
Chronic kidney failure
Clinical Research
Complications and side effects
Consent
Cross-Sectional Studies
Data analysis
Data collection
Diabetes
Endothelium
Endothelium, Vascular - physiopathology
Funding
Heart attacks
Humans
Hypertension
Hypertension - diagnosis
Hypertension - epidemiology
Hypertension - physiopathology
Hypotheses
Internal Medicine
Kidney diseases
Lasers
Male
Medicine
Medicine & Public Health
Microcirculation - physiology
Microvessels - physiopathology
Middle Aged
Mortality
Nephrology
Older people
Participation
R&D
Renal Insufficiency, Chronic - diagnosis
Renal Insufficiency, Chronic - epidemiology
Renal Insufficiency, Chronic - physiopathology
Research & development
Research Article
Risk Factors
Studies
Urine
Vascular disease
Laser Doppler flowmetry
Blood pressure
Endothelial function
Albuminuria
CKD
ISSN:1471-2369, 1471-2369
Online Access:Get full text
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Summary:Background Impairment in glomerular endothelial function likely plays a major role in the development of albuminuria and CKD progression. Glomerular endothelial dysfunction may reflect systemic microvascular dysfunction, accounting in part for the greater cardiovascular risk in patients with albuminuria. Prior studies of vascular function in CKD have focused on conduit artery function or those with ESRD, and have not examined microvascular endothelial function with albuminuria. Methods We conducted a cross-sectional study among older hypertensive male veterans with stage 1–4 CKD, and hypertensive controls without CKD. Microvascular function was quantified by two distinct Laser-Doppler flowmetry (LDF) measures: peak responses to 1) post-occlusive reactive hyperemia (PORH) and 2) thermal hyperemia (TH), measured on forearm skin. Associations of each LDF measure with albuminuria, eGFR, and CKD status were estimated using correlation coefficients and multiple linear regression, accounting for potential confounders. Results Among 66 participants (mean age 69.2 years), 36 had CKD (mean eGFR 46.1 cc/min/1.73 m 2 ; 30.6 % with overt albuminuria). LDF responses to PORH and TH were 43 and 39 % significantly lower in multivariate analyses among those with macroalbuminuria compared to normoalbuminuria, (β= − 0.42, p  = 0.009 and β= −0.37, p  = 0.01, respectively). Those with CKD had a 23.9 % lower response to PORH compared to controls ( p  = 0.02 after adjustment). In contrast, TH responses did not differ between those with and without CKD. Conclusions Microvascular endothelial function was strongly associated with greater albuminuria and CKD, independent of diabetes and blood pressure. These findings may explain in part the excess systemic cardiovascular risk associated with albuminuria and CKD.
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ISSN:1471-2369
1471-2369
DOI:10.1186/s12882-016-0303-x