科研之友
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摘要
Increased arterial stiffness is a marker of vasculopathy in chronic kidney disease (CKD) patients, suggesting a significant cardiovascular damage. Detection of arterial stiffness provides physicians with useful prognostic information independent of traditional cardiovascular (CV) risk factors. In addition, this knowledge may help guide appropriate therapeutic choices and monitor the effectiveness of antihypertensive therapies. We review the relationship between arterial stiffness and CKD, as well as the prognostic implications of increased arterial stiffness and the potential therapeutic strategies to ameliorate arterial compliance and outcome in CKD. 1. Introduction Traditional CV risk factors are of major importance to identify subjects at risk for cardiovascular disease (CVD). However, in spite of a significant over-representation, traditional CV risk factors do not accurately predict survival in CKD patients. Hence, several new biomarkers of CV risk and disease have been identified in the hope to refine the CV risk assessment. It is important to differentiate between circulating and tissue biomarkers. Serum concentration of circulating biomarkers may vary substantially according to the instant risk at which an individual is exposed. Nevertheless, several factors may influence and confound their serum levels, and a recent article questioned the added value of the use of multiple serum biomarkers to refine the risk assessment and outcome prediction [1]. To the contrary, tissue biomarkers such as vascular calcification or arterial stiffness are signs of true tissue damage rather than risk factors. In other words, they reflect the cumulative exposure to damaging factors that have harmed the cardiovascular system. Notably, a growing body of evidence suggests that tissue biomarkers can be useful in combination with traditional CV risk factors to assess the CV risk of a single individual. Indeed, arterial stiffness or vascular calcification evaluation adds a significant and independent contribution in the prediction of microvascular damage of the heart, brain, retina, and kidney as well as CV outcome. The usefulness of a biomarker depends on its accuracy in detecting the disease and in guiding treatment. The aim of this paper is to summarize the available evidence that supports the use of arterial stiffness assessment in CKD patients. 2. Vascular Remodeling and Arterial Stiffness Large central arteries play a key role in converting the pulsatile cardiac outflow into a continuous blood flow throughout the arterial tree. In systole, the heart pushes a volume
- 出版日期2011
