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Sági B, Peti A, Lakatos O, Gyimesi T, Sulyok E, Wittmann I, Csiky B. Pro- and anti-inflammatory factors, vascular stiffness and outcomes in chronic hemodialysis patients. Physiol Int 2020; 107:256-266. [DOI: 10.1556/2060.2020.00026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 03/12/2020] [Indexed: 11/19/2022]
Abstract
AbstractObjectiveIn this observational study we addressed accelerated arteriosclerosis (AS) in patients with chronic renal failure (CRF) on hemodialysis (HD) by measuring vascular stiffness (VS) parameters and attempted to relate them to pro-inflammatory and protective factors.Patients96 consecutive patients receiving regular HD were included. 20 adult patients without major renal, cardiovascular or metabolic morbidities served as controls.MethodsAS parameters (carotid-femoral pulse wave velocity – PWV, aortic augmentation index – Aix) were measured by using applanation tonometry (SphygmoCor, AtCor Medical, Sidney). In addition to routine laboratory tests 25(OH) vitamin D3 (vitamin D3) and high-sensitivity C-reactive protein (hsCRP) were quantified by immunometric assay; whereas fetuin-A, α-Klotho, tumor necrosis factor-α (TNF-α) and transforming growth factor-β1 (TGF-β1) were determined by ELISA.ResultsPro-inflammatory biomarkers (hsCRP, TNF-α and TGF-β1) were markedly elevated (P < 0.01), while anti-inflammatory factors (fetuin-A: P < 0.05, α-Klotho: P < 0.01, vitamin D3: P < 0.01) significantly depressed in HD patients when compared to controls. PWV was significantly affected only by total cholesterol, fetuin-A and dialysis time. Multiple linear regression analyses revealed that several clinical and laboratory parameters were associated with pro- and anti-inflammatory biomarkers rather than VS. The impact of baseline clinical and biochemical variables on outcome measures were also analyzed after three-year follow-up, and it was demonstrated that low levels of vitamin D, α-Klotho protein and fetuin-A were related to adverse cardiovascular outcomes, whereas all-cause mortality was associated with elevated hsCRP and depressed vitamin D.ConclusionsOur results provide additional information on the pathomechanism of accelerated AS in patients with CRF, and documented direct influence of pro- and anti-inflammatory biomarkers on major outcome measures.
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Affiliation(s)
- B. Sági
- 1FMC Dialysis Center Pécs, Pécs, Hungary
- 22nd Department of Medicine and Nephrology-Diabetes Center, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | - A. Peti
- 3Department of Laboratory Medicine, Siófok Hospital, Siófok, Hungary
| | - O. Lakatos
- 4Department of Pediatrics, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | - T. Gyimesi
- 22nd Department of Medicine and Nephrology-Diabetes Center, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | - E. Sulyok
- 5Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary
| | - I. Wittmann
- 22nd Department of Medicine and Nephrology-Diabetes Center, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | - Botond Csiky
- 1FMC Dialysis Center Pécs, Pécs, Hungary
- 22nd Department of Medicine and Nephrology-Diabetes Center, Faculty of Medicine, University of Pécs, Pécs, Hungary
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Sági B, Késői I, Késői B, Vas T, Csiky B, Kovács T, Nagy J. Arterial stiffness may predict renal and cardiovascular prognosis in autosomal-dominant polycystic kidney disease. Physiol Int 2018; 105:145-156. [DOI: 10.1556/2060.105.2018.2.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background and aims
Autosomal-dominant polycystic kidney disease (ADPKD) is one of the most common causes of end-stage renal disease (ESRD). The most important cause of death among ADPKD patients is cardiovascular (CV). The aim of this study was to examine the prognostic significance of arterial stiffness on CV and renal outcomes in ADPKD.
Methods
A total of 55 patients with ADPKD were examined. Pulse wave velocity was determined and stiffness index (SIDVP) was calculated. Combined primary endpoints (CV and renal) were major CV events (myocardial infarction, stroke, and CV intervention) as CV endpoints, and attaining of ESRD or start of renal replacement therapy as renal endpoints. Secondary endpoints were CV or renal endpoints separately.
Results
The mean age of those 55 ADPKD patients was 45 ± 12 years, 21 patients were male. The average value of the SIDVP was 11.11 ± 2.22 m/s. The patients were divided into two groups by the cutoff value of 11 m/s of SIDVP and then outcomes were analyzed. In the higher arterial stiffness group (SIDVP > 11 m/s), occurrence of combined primary endpoint (CV and renal) was significantly higher than in the group with more elastic arteries (p = 0.033). A statistically significant difference was found in the renal endpoints (p = 0.018), but not in the CV endpoints (p = 0.952) between the two groups.
Conclusions
Increased arterial stiffness predicts the onset of ESRD in ADPDK. Assessment of SIDVP appears to be a useful method for estimating the renal and CV prognosis in ADPKD.
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Affiliation(s)
- B Sági
- 1 2nd Department of Internal Medicine and Nephrological Centre, Clinical Centre, Medical School, University of Pécs, Pécs, Hungary
| | - I Késői
- 2 Internal Medicine Department, Mining Rehabilitation and Night Time Sanatorium, Health Centre of Komló, Komló, Hungary
| | - B Késői
- 3 Department of Adult Cardiology, György Gottsegen National Institute of Cardiology, Budapest, Hungary
| | - T Vas
- 1 2nd Department of Internal Medicine and Nephrological Centre, Clinical Centre, Medical School, University of Pécs, Pécs, Hungary
| | - B Csiky
- 1 2nd Department of Internal Medicine and Nephrological Centre, Clinical Centre, Medical School, University of Pécs, Pécs, Hungary
| | - T Kovács
- 1 2nd Department of Internal Medicine and Nephrological Centre, Clinical Centre, Medical School, University of Pécs, Pécs, Hungary
| | - J Nagy
- 1 2nd Department of Internal Medicine and Nephrological Centre, Clinical Centre, Medical School, University of Pécs, Pécs, Hungary
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Sági B, Késoi I, Vas T, Csiky B, Kovács T, Nagy J. THE PROGNOSTIC ROLE OF HEART RATE RECOVERY AFTER EXERCISE IN IGA NEPHROPATHY. J Hypertens 2018. [DOI: 10.1097/01.hjh.0000539517.12352.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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