title: Arterial remodeling associates with CKD progression.
abstract: In CKD, large arteries remodel and become increasingly stiff. The greater pulsatile pressure reaching the glomerulus as a result of increased aortic stiffness could induce renal damage, suggesting that the stiffening and remodeling of large arteries could affect the progression of CKD. We measured carotid-femoral pulse wave velocity, aortic pressure and carotid remodeling and stiffness parameters in 180 patients with CKD (mean measured GFR, 32 ml/min per 1.73 m(2)) and followed them prospectively for a mean of 3.1 years. During follow-up, carotid stiffness significantly increased (+0.28 ± 0.05 m/s; P<0.0001) but aortic stiffness did not. Carotid intima-media thickness decreased significantly during follow-up and the internal diameter of the carotid increased, producing increased circumferential wall stress (+2.08 ± 0.43 kPa/yr; P<0.0001). In a linear mixed model, circumferential wall stress significantly associated with faster GFR decline after adjustment for risk factors of cardiovascular disease and progression of CKD. In a multivariable Cox model, carotid circumferential wall stress and pulse pressure independently associated with higher risk for ESRD. None of the arterial stiffness parameters associated with progression of CKD. In conclusion, maladaptive remodeling of the carotid artery and increased pulse pressure independently associate with faster decline of renal function and progression to ESRD.
authors.affiliation: Department of Pharmacology and Institut National de la Santé et de la Recherche Médicale U970-PARCC, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, 20, rue Leblanc, 75015 Paris, France; mariebriet1@free.fr
authors.forename: Marie
authors.initials: M
authors.lastname: Briet
authors.forename: Cédric
authors.initials: C
authors.lastname: Collin
authors.forename: Alexandre
authors.initials: A
authors.lastname: Karras
authors.forename: Stéphane
authors.initials: S
authors.lastname: Laurent
authors.forename: Erwan
authors.initials: E
authors.lastname: Bozec
authors.forename: Christian
authors.initials: C
authors.lastname: Jacquot
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Stengel
authors.forename: Pascal
authors.initials: P
authors.lastname: Houillier
authors.forename: Marc
authors.initials: M
authors.lastname: Froissart
authors.forename: Pierre
authors.initials: P
authors.lastname: Boutouyrie
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000209:etiology; D002339:Carotid Arteries / Q000473:pathology*; D002908:Chronic Disease; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models