VASCULAR RIGIDITY IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AT DIFFERENT STAGES OF DIABETIC NEPHROPATHY
Keywords:
diabetes mellitus, chronic kidney disease, pulse wave velocity, arterial stiffnessAbstract
Background and Aims: Arterial stiffness is associated with increased risk for targetorgan damage, cardiovascular events and overall mortality in the general population, patients with diabetes mellitus and patients with chronic kidney disease (CKD) of all stages. The aim of this study is assessment of vascular stiffness and endothelial function in patients with type 2 diabetes at different stages of diabetic nephropathy and without it.
Materials and methods. We examined 155 patients with DM2 aged 18 to 70 years, received planned inpatient treatment at the RSNPMC of Endocrinology named after Academician Ya.Kh. Turakulova. The criterion for forming groups is the stage of diabetic nephropathy. Control group consisted of 33 patients without diabetic nephropathy. In addition to routine tests for the diagnosis of CKD, sphygmography (measurement of pulse wave velocity (PWV)) and central (aortic) BP) were performed using the SphygmoCor XCEL device (AtCor Medical, Sydney, Australia). Informed consent was obtaining from each patient prior to the study.
Results. Spearman's correlation analysis revealed a significant relationship between the pulse wave velocity - PWV, the age of the subjects (CC=0.379; r=0.000) and the duration of diabetes (CC=0.211; r=0.015). In patients with DM2 in the control group, these indicators averaged 8.4±1.5, and in patients of the main group, on average, 9.89±2.4; a significant increase in PWV was found with increasing severity of CKD (CC=3.72, r =0.004). However, no dependence of PWV indices on the level of glycemic compensation was found (CC=-0.081; p=0.367).
Discussion. Diabetic CKD patients present higher arterial stiffness than non-CKD counterparts. Increase in the stiffness of the arteries, the progression of DN may be an early marker of macrovascular lesions even in patients without hyperlipidemia.
References
Низамов У.И., Тригулова Р.Х., Шек А.Б., Тахирова Ф.А, Алиханова Н.М., Акрамова Г.Г, Акбаров З.С. Жёсткость сосудистой стенки у больных сахарным диабетом 2го типа. - Назарий ва клиник тиббиёт журнали. 5-2017.78-82бб.
Briet M, Collin C, Karras A, Laurent S, Bozec E, Jacquot C, Stengel B, Houillier P, Froissart M, Boutouyrie P; Nephrotest Study Group. Arterial remodeling associates with CKD progression.J Am Soc Nephrol. 2011; 22:967–974. doi: 10.1681/ASN.2010080863.
Covic A, Haydar AA, Bhamra-Ariza P, Gusbeth-Tatomir P, Goldsmith DJ. Aortic pulse wave velocity and arterial wave reflections predict the extent and severity of coronary artery disease in chronic kidney disease patients. J Nephrol. 2005;18(4):388-396.
Ferreira JP, Girerd N, Pannier B, Rossignol P, London GM. High Pulse-Wave Velocity Defines a Very High Cardiovascular Risk Cohort of Dialysis Patients under Age 60. Am J Nephrol. 2017;45(1):72-81. doi:10.1159/000453338.
Ford ML, Tomlinson LA, Chapman TP, Rajkumar C, Holt SG: Aortic stiffness is independently associated with rate of renal function decline in chronic kidney disease stages 3 and 4. Hypertension 55: 1110–1115, 2010.
Gansevoort R. T., Correa-Rotter R., Hemmelgarn B. R., Jafar T. H., Heerspink H. J., Mann J. F., et al. (2013). Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and prevention. Lancet 382 339–352.
Go A. S., Chertow G. M., Fan D., Mcculloch C. E., Hsu C. Y. (2004). Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N. Engl. J. Med. 351 1296–1305. 10.1056/nejmoa041031.
Laurent S, Cockcroft J, Van Bortel L et al (2006) Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 27:2588–2605.
Legrand M., Rossignol P. (2020). Cardiovascular Consequences of Acute Kidney Injury. N. Engl. J. Med. 382 2238–2247.
Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, et al.. 2013 ESH/ESC Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertension (2013) 31(7):1281–357. doi: 10.1097/01.hjh.0000431740.32696.cc.
Mattace-Raso FU, van der Cammen TJ, Hofman A, van Popele NM, Bos ML, Schalekamp MA, Asmar R, Reneman RS, Hoeks AP, Breteler MM, Witteman JC: Arterial stiffness and risk of coronary heart disease and stroke: The Rotterdam Study. Circulation 113: 657–663, 2006.
Michener KH, Mitchell GF, Noubary F, Huang N, Harris T, Andresdottir MB, Palsson R, Gudnason V, Levey AS. Aortic stiffness and kidney disease in an elderly population.Am J Nephrol. 2015; 41:320–328. doi: 10.1159/000431332.
Quinn CE, Lockhart CJ, Hamilton PK, Loughrey CM, McVeigh GE. Effect of Pioglitazone on Endothelial Function in Impaired Glucose Tolerance. Diabetes Obes Metab (2010) 12(8):709–15. doi: 10.1111/j.1463-1326.2010.01224.х.
Stehouwer, C.D.A., Henry, R.M.A. & Ferreira, I. Arterial stiffness in diabetes and the metabolic syndrome: a pathway to cardiovascular disease. Diabetologia 51.
Takenaka T, Mimura T, Kanno Y, Suzuki H: Qualification of arterial stiffness as a risk factor to the progression of chronic kidney diseases. Am J Nephrol 25: 417–424, 2005.
Tonelli M, Wiebe N, Culleton B, House A, Rabbat C, Fok M, McAlister F, Garg AX. Chronic kidney disease and mortality risk: a systematic review. J Am Soc Nephrol. 2006 Jul;17(7):2034-47. doi: 10.1681/ASN.2005101085. Epub 2006 May 31. PMID: 16738019.
Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol. 2010;55(13):1318-1327. doi:10.1016/j.jacc.2009.10.061.
Weber T, Ammer M, Gündüz D, Bruckenberger P, Eber B, Wallner M. Association of increased arterial wave reflections with decline in renal function in chronic kidney disease stages 3 and 4.Am J Hypertens. 2011; 24:762–769. doi: 10.1038/ajh.2011.45.
Zieman SJ, Melenovsky V, Kass DA. Mechanisms, pathophysiology, and therapy of arterial stiffness. Arterioscler Thromb Vasc Biol. (2005) 25:932–43. 10.1161/01.ATV.0000160548.78317.29.
