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Bellos I, Kontzoglou K, Perrea DN. Markers of endothelial dysfunction and arterial stiffness in patients with early-stage autosomal dominant polycystic kidney disease: A meta-analysis. Int J Clin Pract 2021; 75:e13721. [PMID: 32946652 DOI: 10.1111/ijcp.13721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/11/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Autosomal dominant polycystic kidney disease (ADPKD) is characterised by increased rates of cardiovascular complications leading to significant morbidity and mortality. This meta-analysis aims to evaluate whether the disease is linked to endothelial dysfunction and arterial stiffness during its early stages. METHODS Medline, Scopus, CENTRAL, Web of Science, Clinicaltrials.gov and Google Scholar databases comparing ADPKD patients with preserved renal function to healthy controls were included. The outcomes of interest were brachial flow-mediated dilatation, carotid-femoral pulse wave velocity, augmentation index, carotid intima-media thickness and central systolic blood pressure, plasma ADMA or homocysteine levels. Standardised mean differences (SMDs) were estimated by a random-effects model in R-3.6.3. RESULTS A total of 27 studies were included, comprising 1967 individuals. ADPKD was linked to significantly lower flow-mediated dilatation (SMD: -1.44, 95% CI: [-2.35, -0.53]) and higher pulse wave velocity (SMD: 1.44, 95% CI: [0.22, 2.66]) and carotid intima-media thickness (SMD: 1.02, 95% CI: [0.57, 1.47]). No significant associations were noted regarding augmentation index (SMD: 0.62, 95% CI: [-0.19, 1.43]) and central systolic blood pressure (SMD: 1.84, 95% CI: [-0.12, 3.80]). Plasma homocysteine was significantly higher in ADPKD (SMD: 0.81, 95% CI: [0.16, 1.45]), while no difference was calculated for ADMA levels (SMD: 1.14, 95% CI: [-0.25, 2.53]). CONCLUSIONS Early-stage ADPKD patients present increased vascular stiffness and endothelial dysfunction, as reflected by low flow-mediated dilatation and elevated values of pulse wave velocity, carotid intima-media thickness and plasma homocysteine. The exact effects of early arterial stiffness on long-term outcomes remain to be elucidated.
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Affiliation(s)
- Ioannis Bellos
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Kontzoglou
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Despina N Perrea
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Hamzaoui M, Lamy G, Bellien J, Guerrot D. [Cardiovascular disorders in autosomal dominant polycystic kidney disease]. Nephrol Ther 2021; 17:18-29. [PMID: 33431311 DOI: 10.1016/j.nephro.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 08/13/2020] [Accepted: 09/02/2020] [Indexed: 11/30/2022]
Abstract
Autosomal dominant polycystic kidney disease is the most frequent genetic kidney disease. Cardiovascular disorders associated with autosomal dominant polycystic kidney disease are multiple and may occur early in life. In autosomal dominant polycystic kidney disease cardiovascular morbidity and mortality are related both to the nonspecific consequences of chronic kidney disease and to the particular phenotype of autosomal dominant polycystic kidney disease. Compared to the general population, patients with autosomal dominant polycystic kidney disease present an increased prevalence of hypertension, left ventricular hypertrophy, atrial fibrillation, valvular diseases, aneurisms and arterial dissections. This review article provides an update on cardiovascular disorders associated with autosomal dominant polycystic kidney disease and recent pathophysiological developments.
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Affiliation(s)
- Mouad Hamzaoui
- Inserm U1096, FHU REMOD-VHF, UniRouen, Normandie Université, 76000 Rouen, France; Service de néphrologie, CHU de Rouen, 76000 Rouen, France
| | - Gaspard Lamy
- Inserm U1096, FHU REMOD-VHF, UniRouen, Normandie Université, 76000 Rouen, France; Service de néphrologie, CHU de Rouen, 76000 Rouen, France
| | - Jérémy Bellien
- Inserm U1096, FHU REMOD-VHF, UniRouen, Normandie Université, 76000 Rouen, France; Service de pharmacologie clinique, CHU de Rouen, 76000 Rouen, France
| | - Dominique Guerrot
- Inserm U1096, FHU REMOD-VHF, UniRouen, Normandie Université, 76000 Rouen, France; Service de néphrologie, CHU de Rouen, 76000 Rouen, France.
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Esen B, Gokmen ES, Kaya M, Ozkan B, Atay AE. The relation of anthropometric measurements and insulin resistance in patients with polycystic kidney disease. J Transl Int Med 2016; 4:127-134. [PMID: 28191534 DOI: 10.1515/jtim-2016-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine the frequency of insulin resistance (IR) and its relation with anthropometric measurements in patients with autosomal dominant polycystic kidney disease (ADPKD). MATERIAL AND METHODS Nonobese 82 patients with ADPKD and 58 age matched healthy controls were enrolled into the study. None of participants were diabetic or receiving renal replacement therapies (RRT). IR was determined by homeostasis model assessment of insulin resistance (HOMA-IR) formula. Tanita body composition analyzer was used for anthropometric measurements. Creatinine clearance of participant were assessed by the modification of diet in renal diseases (MDRD). RESULTS Patients with ADPKD had significantly higher level of urea and creatinine, microalbuminuria, and lower level of MDRD. Body fat distribution and HOMA-IR in both the groups were similar. Systolic and diastolic blood pressure of patients were higher than those of controls. CONCLUSION We failed to determine a higher frequency of IR among patients with ADPKD.
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Affiliation(s)
- Bennur Esen
- Department of Nephrology, Acibadem Taksim Hospital, Istanbul, Turkey
| | - Emel Sağlam Gokmen
- Bagcilar Education and Research Hospital, Internal Medicine, Istanbul, Turkey
| | - Mahmut Kaya
- Department of Internal Medicine, School of Medicine, Yeni Yuzyil University, Istanbul, Turkey
| | - Burak Ozkan
- Department of Urology, School of Medicine, Acibadem University, Istanbul, Turkey
| | - Ahmet Engin Atay
- Bagcilar Education and Research Hospital, Internal Medicine, Istanbul, Turkey
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Yang B, Chen S, Yang G, Mei C, Ong A, Mao Z. New onset diabetes after kidney transplantation in patients with autosomal dominant polycystic kidney disease: systematic review protocol. BMJ Open 2015; 5:e008440. [PMID: 26546139 PMCID: PMC4636618 DOI: 10.1136/bmjopen-2015-008440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disorder with numerous cysts developing in bilateral kidneys. Meanwhile, ADPKD can also be regarded as a systemic disease because the cystic and non-cystic abnormalities could be identified in multiple organs in patients with ADPKD. Several lines of evidence suggest the risk of post-transplant diabetes mellitus or new-onset diabetes after transplantation (NODAT) is higher in patients with ADPKD compared with non-ADPKD renal recipients, but the available results are conflicting. We describe the protocol of a systematic review and meta-analysis for investigating the risk of NODAT in patients with ADPKD. METHODS AND ANALYSIS PubMed, EMBASE and The Cochrane Library will be searched. Cohort studies irrespective of language and publication status, comparing the incidence of NODAT in renal recipients with ADPKD and other kidney disease will be eligible. We will assess heterogeneity among studies. Along with 95% CIs, dichotomous data will be summarised as risk ratios; numbers needed to treat/harm and continuous data will be given as standard mean differences. Excluding outliers and testing small sample size studies if our results are robust, sensitivity analysis will be carried out. ETHICS AND DISSEMINATION Ethical approval is not required because this study includes no confidential personal data or patient interventions. The review findings will be helpful in designing and implementing future studies and will be of interest to a wide range of readers, including healthcare professionals, researchers, health service managers and policymakers. The systematic review will be published in a peer-reviewed journal and disseminated electronically and in print. TRIAL REGISTRATION NUMBER The study protocol has been registered in PROSPERO (http://www.crd.york.ac.uk/PROSPERO/) under registration number CRD42014009677.
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Affiliation(s)
- Bo Yang
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Sixiu Chen
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Guang Yang
- No. 1 Cadets Company, Second Military Medical University, Shanghai, People's Republic of China
| | - Changlin Mei
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Albert Ong
- Kidney Genetics Group, Academic Nephrology Unit, The Henry Wellcome Laboratories for Medical Research, University of Sheffield Medical School, Sheffield, UK
| | - Zhiguo Mao
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
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Gul CB, Yildiz A, Ersoy A, Kahvecioglu S, Asiltas B, Yildirim F, Ermurat S, Sag S, Oruc A, Gullulu S, Gullulu M. Correlation between arterial stiffness and inflammatory markers in autosomal dominant polycystic kidney disease patients with preserved renal function. Int Urol Nephrol 2015; 47:1187-94. [PMID: 26047596 DOI: 10.1007/s11255-015-1022-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 05/27/2015] [Indexed: 12/13/2022]
Abstract
AIM To evaluate the association between arterial stiffness and inflammatory markers including C-reactive protein (CRP), pentraxin 3 (PTX3) and neutrophil-to-lymphocyte ratio (NLR) in autosomal dominant polycystic kidney disease (ADPKD) patients with preserved renal function. METHODS A total of 52 ADPKD patients [mean (SD) age 38.2 (12.8) years, 69.2 % were females] with preserved renal function and 25 healthy volunteers [mean (SD) age 35.5 (6.5) years, 48.0 % were females] were included. Data on patient characteristics, blood biochemistry, inflammatory markers [PTX3 (pg/mL), CRP (mg/dL) and NLR] and arterial stiffness [large artery elasticity index (LAEI) (mL/mmHg × 10) and small artery elasticity index (SAEI) (mL/mmHg × 100)] were recorded in patient and control groups. Correlation between inflammatory markers and arterial stiffness parameters was analysed in patients. RESULTS Overall, 42.3 % of ADPKD patients were hypertensive and 44.4 % were receiving renin-angiotensin-aldosterone system (RAAS) blockade therapy. Median levels for PTX3 [442.0 (20.0-4140.0) pg/mL vs. 220.5 (14.7-393.0) pg/mL, p < 0.001] and SAEI [4.90 (1.60-11.80) mL/mmHg × 100 vs. 6.45 (2.80-15.70) mL/mmHg × 10, p = 0.013] were significantly higher in ADPKD patients than in controls. PTX3 and CRP were not correlated with arterial elasticity, while NLR was significantly correlated with LAEI negatively (Rho = -0.278, p = 0.042). CONCLUSION In conclusion, our findings revealed increased PTX3 levels and reduced SAEI in patients as compared with controls, while no correlation between inflammatory markers studied and the small artery elasticity.
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Affiliation(s)
- Cuma Bulent Gul
- Department of Nephrology, Sevket Yılmaz Training and Research Hospital, Bursa, Turkey,
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The polymorphism of the ACE gene affects left ventricular hypertrophy and causes disturbances in left ventricular systolic/diastolic function in patients with autosomal dominant polycystic kidney disease. ScientificWorldJournal 2014; 2014:707658. [PMID: 24672357 PMCID: PMC3929983 DOI: 10.1155/2014/707658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 10/10/2013] [Indexed: 11/26/2022] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is one of the most frequently occurring autosomal diseases inherited in the dominant manner. Due to this, lesions in the cardiovascular system of ADPKD patients have caught the attention of clinical investigators worldwide. The aim of the study was to analyse cardiovascular complications in ADPKD patients with a focus on left ventricular hypertrophy (LVH) and selected components of its systolic/diastolic function based on echocardiography. The study was conducted on 55 patients with ADPKD (24 males, 31 females), subdivided into three groups according to the stage of chronic kidney disease (CKD). The patient group with ADPKD and ESRD (group C) manifested an increased incidence of the D allele as compared to group A and group B (χ2 = 4.217, P = 0.04). In all ADPKD patients with the DD genotype, left ventricular mass (LVM), posterior wall thickness (PWT), and interventricular septal thickness (IVS) were significantly higher compared to patients possessing the II and ID genotypes (P < 0.02, P < 0.003, and P < 0.009, resp.). The DD genotype exists more frequently in ADPKD patients with ESRD and is associated with a higher occurrence of LVH and disturbances in systolic-diastolic function when compared to ADPKD ESRD patients with the II and ID genotypes.
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Turkmen K, Tufan F, Selçuk E, Akpınar T, Oflaz H, Ecder T. Neutrophil-to-lymphocyte ratio, insulin resistance, and endothelial dysfunction in patients with autosomal dominant polycystic kidney disease. Indian J Nephrol 2013; 23:34-40. [PMID: 23580803 PMCID: PMC3621236 DOI: 10.4103/0971-4065.107195] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Endothelial dysfunction (ED), insulin resistance (IR), and inflammation are risk factors for increased cardiovascular morbidity and mortality in autosomal dominant polycystic kidney disease (ADPKD). ADPKD patients may have increased carotid intima-media thickness (CIMT) and decreased coronary flow velocity reserve (CFVR). The neutrophil-to-lymphocyte ratio (NLR) was introduced as a marker to determine inflammation in various disorders. We aimed to investigate the relationship between NLR and IR, CFVR, CIMT, and the left ventricular mass index (LVMI) in normotensive ADPKD patients. Twentynine ADPKD patients (age 38.8 ± 10.2 years; 8 men and 21 women) and 19 healthy controls (age 33.8 ± 7.4 years; 8 men and 11 women) were included in this cross-sectional study. CFVR was calculated with echocardiography as the ratio of hyperemic to baseline diastolic peak coronary flow velocities. CIMT was measured in the distal common carotid artery by using a 10-MHz linear echocardiography probe. HOMA-IR was calculated NLR was calculated as the ratio of the neutrophil and lymphocyte counts. Age, sex, body mass index, and levels of glucose, creatinine, low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol, triglycerides, C-reactive protein (CRP), microalbuminuria, and creatinine clearance were similar between ADPKD patients and healthy subjects. NLR, CIMT, LVMI, and HOMA-IR were significantly higher and CFVR values were significantly lower in patients with ADPKD compared to that in healthy subjects. NLR showed positive correlation with CIMT, HOMA, insulin, glucose, and HDL cholesterol levels, while it was inversely correlated with CFVR and albumin level in all subjects. In patients with ADPKD, NLR showed positive correlation with HDL cholesterol level and inverse correlation with LVMI and albumin level. NLR that was found to be increased in patients with ADPKD may be a readily available marker of inflammation and ED.
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Affiliation(s)
- K Turkmen
- Department of Internal Medicine, Selcuk University, Meram School of Medicine, Division of Nephrology, Konya, Turkey
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