title: Mild renal dysfunction as a non-traditional cardiovascular risk factor?-Association of cystatin C-based glomerular filtration rate with flow-mediated vasodilation.
abstract: OBJECTIVE
  Chronic kidney disease, at least in its advanced stages, can be regarded as a non-traditional cardiovascular risk factor. The purpose of this study was to evaluate whether early stages of renal dysfunction are associated with flow-mediated vasodilatation, as an early marker of the atherosclerotic disease process.
  
  
  METHODS
  In 1515 subjects (753 females) from the population-based Study of Health in Pomerania, the relationship between flow-mediated vasodilatation of the brachial artery (cuff occlusion of the forearm for 5 min) and glomerular filtration rate, estimated on the basis of serum cystatin C levels, was analyzed under consideration of various cardiovascular risk factors.
  
  
  RESULTS
  Flow-mediated vasodilatation was 5.75 + or - 0.16% in women and 4.29+/-0.12% in men (mean + or - SEM). Glomerular filtration rate amounted to 94.2 + or - 0.7 ml/min/1.73 m(2), with 8.1% subjects with glomerular filtration rate < or = 60 ml/min/1.73 m(2). Flow-mediated vasodilatation significantly correlated with glomerular filtration rate in the entire population (r=0.237, p<0.001), in women (r=0.224, p<0.001) and in men (r=0.168, p<0.001). Adjusting for age and multiple cardiovascular risk factors and also for high-sensitive C-reactive protein levels revealed a significant association of flow-mediated vasodilatation and glomerular filtration rate in women (p=0.01), but not in men, with similar results when the analyses were restricted to individuals with glomerular filtration rate >60 ml/min/1.73 m(2).
  
  
  CONCLUSIONS
  Mild reduction in renal function is associated with alterations in endothelial function in females. Hence, very mild alterations in kidney function may also be regarded as a cardiovascular risk factor at least in women.
authors.affiliation: Klinik und Poliklinik für Innere Medizin B, Universitätsklinikum der Ernst-Moritz-Arndt-Universität Greifswald, Friedrich-Löffler Str. 23 a, 17487 Greifswald, Germany. ThorstenReffelmann@web.de
authors.forename: Thorsten
authors.initials: T
authors.lastname: Reffelmann
authors.forename: Alexander
authors.initials: A
authors.lastname: Krebs
authors.forename: Till
authors.initials: T
authors.lastname: Ittermann
authors.forename: Klaus
authors.initials: K
authors.lastname: Empen
authors.forename: Astrid
authors.initials: A
authors.lastname: Hummel
authors.forename: Marcus
authors.initials: M
authors.lastname: Dörr
authors.forename: Henry
authors.initials: H
authors.lastname: Völzke
authors.forename: Stephan B
authors.initials: SB
authors.lastname: Felix
mesh_terms: D015415:Biomarkers; D001916:Brachial Artery / Q000473:pathology; D002318:Cardiovascular Diseases / Q000150:complications* / Q000473:pathology*; D055316:Cystatin C / Q000096:biosynthesis*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000473:pathology; D007674:Kidney Diseases / Q000150:complications* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014664:Vasodilation
chemical_list: D015415:Biomarkers; D055316:Cystatin C