Association between markers of collagen turnover, arterial stiffness and left ventricular hypertrophy in chronic kidney disease (CKD): the Renal Research Institute (RRI)-CKD Study

作者：Dellegrottaglie Santo; Sands Robin L; Gillespie Brenda W; Gnanasekaran Gowrishankar; Zannad Faiez; Sengstock David; Finkelstein Frederic; Kiser Margaret; Eisele George; Hinderliter Alan L; Levin Nathan W; Cattan Valerie; Saran Rajiv; Rajagopalan Sanjay^*

来源：Nephrology Dialysis Transplantation, 2011, 26(9): 2891-2898.

DOI：10.1093/ndt/gfr186

• kidney disease
• vascular function
• ventricular hypertrophy

Background. Markers of collagen turnover have not been well studied in the context of cardiovascular disease in patients with chronic kidney disease (CKD). We investigated the associations between serum markers of collagen turnover [N-terminal procollagen type 3 propeptide (PIIINP) and carboxy-terminal telopeptide (C1TP)] and both pulse wave velocity (PWV) and left ventricular mass index (LVMI) in a CKD cohort.
Methods. The study included 242 patients (mean age 60 +/- 15 years, 53% males, 80% Caucasian, CKD Stages 3-5) from the Renal Research Institute (RRI)-CKD Study. Serum PIIINP and C1TP levels were analyzed by radioimmunoassay. PWV was obtained by applanation tonometry from carotid and femoral pressure wave contours. LVMI was measured by echocardiography. Statistical analyses included Pearson's correlations and multiple linear regression.
Results. Both PIIINP and C1TP values were significantly higher in more advanced stages of CKD (P < 0.05). A positive correlation was demonstrated between PWV and LVMI (r = 0.25, P = 0.0018), persisting after adjustment for potential confounders (partial r = 0.27, P = 0.0009). PIIINP correlated with PWV (r = 0.16, p = 0.029) and LVMI (r 0.16, P 0.0018), while C1TP correlated with LVMI (r = 0.18, P = 0.013) but not with PWV (r = 0.12, P = 0.09). In multivariable analysis adjusting for race, diabetes, estimated glomerular filtration rate (eGFR) and renin-angiotensin- aldosterone system inhibitors, only PWV (beta = 0.45, P = 0.0017) but not LVMI (P 0.09) remained significantly associated with serum PIIINP.
Conclusions. Our results demonstrate the association of PIIINP (but not C1TP), a circulating biomarker of collagen synthesis with arterial stiffness (but not with LVMI) in a CKD cohort, independent of eGFR. This suggests that altered collagen turnover may play a role in the pathogenesis of arterial stiffness in CKD.

• 出版日期2011-9