Arteriograph & Nephrology
In end-stage renal disease (ESRD), the majority of the patients die not because of the renal disease but because of cardiovascular events. Consequently, the cardiovascular risk assessment is of high importance in the field of Nephrology. A large number of evidences have proved the prognostic value of the aortic Pulse Wave Velocity (PWVao) for Cardiovascular (CV) morbidity and mortality in ESRD.
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1. Arterial stiffness & Sri Lankan chronic kidney disease of unknown origin
Chronic kidney disease (CKD) is the gradual loss of kidney function which has a close relationship with cardiovascular disease (CVD) that cause of morbidity and mortality worldwide. Basically increased arterial stiffness which is a characteristic feature of CKD can be used as an independent predictor of mortality and survival in CKD.
This study has followed up three groups of:
- Patients with chronic kidney disease of unknown origin (CKDu)
- Patients with chronic kidney disease of known origin (CKD)
- Apparently healthy people without any chronic kidney disease (Control)
whom assessed by using Arteriograph.
Based on the assessment, brachial and aortic BP were lower in controls than in CKDu and CKD subjects but no different between CKDu and CKD. Interestingly, controls had a lower pulse wave velocity (PWV) compared to subjects with CKDu and CKD. Despite equivalent BP and renal dysfunction, CKDu subjects had a lower PWV than those with CKD. Therefore, measuring of arterial stiffness parameters in general clinical examination seems necessary since PWV is an established independent predictor of mortality and survival in CKD.
2. Serum cystatin C is a determinant of central pressure augmentation index measured by oscillometric method in renal transplant recipients
The first cause of death or graft loss in renal transplant recipients (RTR) is cardiovascular diseases. Serum Cystatin C has been proved to be a superior marker of not only GFR but also excessive arterial stiffness. Therefore, this study aims to extend the association between ScysC and Augmentation index (Aix) seen in the general population to RTR.
Central Hemodynamic Parameters (central blood pressure, central pressure augmentation index and pulse wave velocity) were recorded in the non-fistula arm manner using Arteriograph, a validated oscillometric device. This was followed by measurement of other biological markers such as ScysC.
Results showed a strong positive association between ScysC and Aix in RTR. So, in conclusion the data suggest that arterial stiffness may partially mediate the association between ScysC and cardiovascular risk in renal transplantation.