Pulse Wave Velocity In The Assessment Of Arteriosclerosis In Patients With Chronic Kidney Disease And The Influential Factors

Objective：To assess the arteriosclerosis in patients with chronic kidney disease(CKD) basedon brachial-ankle pulse wave velocity(baPWV) and to find the influential factors.Methods: We collected data from forty four patients who were hospitalized in the SecondAffiliated Hospital of Dalian Medical University from June2013to January2014. Exclusioncriteria were: serious infection, hepatobiliary diseases, tumor, serious arrhythmias, acutemyocardial infarction, heart failure, acute cerebrovascular disease, peripheral vasculardiseases. Forty five individuals, who were examined in the Center of Health Examination inthe same hospital, were enrolled as the control group. With reference to estimated glomerularfiltration rate (eGRF), based on MDRD formula, CKD patients were divided into four groups,6patients with CKD stage2,10patients with CKD stage3,6patients with CKD stage4,22patients with CKD stage5. Basic clinical information of all the patients, including gender,age, body mass index and so on, were collected. Hemoglobin, serum albumin, triglyceride,cholesterol, low density lipoprotein cholesterol, serum creatinine, serum uric acid, serumcalcium, serum phosphorus, were assessed by autobiochemistry machine. Furthermore,corrected serum calcium levels and calcium-phosphorus product were estimated. Serum intactparathyroid hormone (iPTH) was detected by immunoradiometric assay. Serum C-reactiveprotein(CRP) was analyzed by immunoturbidimetry. Japanese VP1000pulse wave detectiondevice was used to evaluate baPWV and blood pressure. The American GE LOGIQ7ultrasonic diagnostic apparatus was used for carotid intima-media thickness (cIMT)measurement. All statistical analyses were performed using SPSS17.0software, andP-values<0.05were considered as statistically significant. Result：1. CKD stage5patients had lower hemoglobin level than the control group and CKDstages2-4patients (P <0.05), lower serum albumin level than the control group and CKDstage2patients (P <0.05), lower triglyceride and cholesterol level than CKD stages3-4patients (P <0.05), lower serum calcium level than the control group and CKD stages2-4patients (P <0.05), higher serum phosphorus than the control group and CKD stages2-3patients (P <0.05), higher serum iPTH level than the control group and CKD stages2-4patients (P <0.05), lower calcium-phosphorus product than CKD stage2patients (P <0.05),higher serum CRP level than the control group and CKD stage2patients (P <0.05), higherserum uric acid than the control group and CKD stages2-4patients (P<0.05). Meanwhile,CKD stages3-4patients had lower hemoglobin and serum albumin levels than the controlgroup and CKD stage2patients (P <0.05), CKD stage4patients had higher triglyceride levelthan the control group and CKD stage2patients (P <0.05).2. CKD stage5patients had higher level of cIMT than the control group and CKD stage2patients (P <0.05), higher plaque incidence than the control group and CKD stages2-4patients (P <0.05). Meanwhile, CKD stages3-4patients had higher plaque incidences thanthe control group and CKD stage2patients (P <0.05), CKD stage2patients had higer plaqueincidence than the control group.3. CKD stage5patients had higher level of baPWV than the control group and CKDstage2patients (P <0.05), CKD stages3-4patients had higher baPWV levels than the controlgroup(P <0.05). CKD stages3-5patients had higher systolic blood pressure levels than thecontrol group(P <0.05), CKD stage3patients had higher systolic blood pressure level thanCKD stage2patients(P <0.05). CKD stage5patients had higher level of diastolic bloodpressure than CKD stage3patients (P<0.05), higher level of pulse pressure than CKD stage2patients (P <0.05).4. Correlation analysis showed baPWV was positively correlated with cIMT (r=0.341, P=0.024). The CKD patients were divided into plaque group and non-plaque group, baPWVof plaque group were (1864.53±315.31) cm/s, non-plaque group were (1590.59±243.50)cm/s, the difference between the two groups was statistically significant (P=0.002). Thecorrelation analysis showed that the levels of baPWV was positively correlated with age（r=0.313，P=0.039）, systolic blood pressure（r=0.790，P=0.000）, pulse pressure (r=0.654， P=0.000）, serum CRP (r=0.477，P=0.001), serum uric acid (r=0.543，P=0.000）and negativelycorrelated with eGFR(r=-0.374，P=0.012). Multiple stepwise regression analysis showed that,after adjustment for age, eGFR and serum CRP, serum uric acid（P=0.001), systolic bloodpressure（P=0.000）and pulse pressure（P=0.018）were independent influencial factors forbaPWV in CKD patients.Conclusions：1. Brachial-ankle pulse wave velocity could be used as a sensitive index inthe early assessment of arteriosclerosis in patients with chronic kidney disease.2. Blood uric acid, systolic blood pressure and pulse pressure were theindependent risk factors of arteriosclerosis in patients with chronic kidney disease.