Função endotelial e rigidez arterial em portadores de doença renal crônica: papel na progressão da doença renal e nos desfechos

Abstract

Chronic kidney disease (CKD) is a worldwide public health problem. Hypertension and diabetes mellitus are the main baseline diseases causing CKD. Cardiovascular disease (CVD) is the main complication of CKD patients. Endothelial dysfunction (ED) and arterial stiffness (AS) are present in patients with atherosclerotic disease and CVD. The aim of this study was to evaluate the role of endothelial dysfunction and arterial stiffness on the progression of CKD and its relation with the outcomes. Longitudinal study, 97 CKD subjects stages 3-4, under regular treatment in an outpatient interdisciplinary clinic for at least 1 year. After the first visit patients were followed for 18,5 ± 3,6 months. Estimated glomerular filtration rate (eGFR) calculated by CKD-EPI equation. Proteinuria analyzed in a urine sample. Biochemistry profile was evaluated every 3 months. Blood pressure (BP) was the mean of 3 measurements. Echocardiogram evaluated left ventricular mass (LVM) and index (LVMI). Endothelial function was evaluated through the technique of flow-mediated dilation (FMD) of the brachial artery, and was measured in the first and final visits. Arterial stiffness (AS) was evaluated in the first visit by measurements of carotid-femoral (CF) and carotid-radial (CR) pulse wave velocity (PWV). SPSS-20. Data are mean ± SD or median (interquartile range). In the first visit we observed age: 64.3 ± 10.1 years; 55% male; eGFR: 30.6 ± 10ml/min/1.73m². Systolic BP: 151.5 ± 22.5mmHg; diastolic BP: 81.1 ± 11.2mmHg; pulse pressure (PP): 70.4 ± 19.4mmHg; FMD: 10.5 ± 6.7%; proteinuria: 309mg/g (135-944); CR-PWV: 9.5 ± 1.7m/s and CF-PWV: 10.8 ± 3.4m/s. Left ventricular hypertrophy (LVH) was present in 54.3%. Renal function decreased -0.96 ± 5.3ml/min/year. FMD and LVMI were not different when comparing the last with the first visit and did not correlate with the eGFR decrease neither with the outcomes. Higher loss of eGFR was associated with increased CF-PWV and proteinuria. Outcomes were not present in 87% of the population. Cardiovascular outcomes were present in 8 patients and were correlated to the increase of CF-PWV and CR-PWV; renal outcomes were present in 5 patients and were correlated to lower eGFR and higher proteinuria. The majority of the population showed stable renal function. In CKD patients (stages 3-4), FMD was not a biomarker of cardiovascular outcomes. The number of outcomes was low after 18 months (13%). Proteinuria was a biomarker for cardiovascular and renal outcomes. The increase of the AS was not present in the majority of the patients, however was useful as a biomarker for cardiovascular outcomes in the studied population.