title: Neointimal hyperplasia and calcification in medium sized arteries in adult patients with chronic kidney disease.
abstract: The nature of arterial changes resulting in cardiovascular events and dialysis vascular access failures in adult predialysis patients is not well known. This study examined intimal changes, calcium deposition, and consequent stiffness in brachial and radial arteries of adult CKD patients. Ten brachial-artery and seven radial-artery specimens were obtained during fistula creation from nine predialysis and eight dialysis-dependent, nondiabetic patients; and age-gender matched controls undergoing coronary bypass grafts (6 radial) or kidney donation (6 renal). Arterial stiffness was measured at baseline. Vessel histology, morphometric analysis of intima-media, and direct quantification of calcium load was performed using standard techniques. Both predialysis and dialysis patients demonstrated significant arterial intimal hyperplasia with intima:media ratio higher than controls (0.13 ± 0.12 vs. 0.02 ± 0.05, p = 0.01). Calcium deposition was demonstrated on histology and the calcium content in patients was higher than controls (34.68 ± 26.86 vs. 10.95 ± 9.18 μg/μg, p = 0.003). The blood vessel calcium content correlated with arterial stiffness (r = 0.64, p = 0.018). This study for the first time describes, and suggests mechanistic linkage between, intimal hyperplasia, pathological calcium deposition, and increased functional arterial stiffness in dialysis and predialysis patients. Our research could serve as a unique window into the in vivo status of the uremic vasculature impacting fistula maturation and cardiovascular disease.
authors.affiliation: Renal and Transplantation Unit, St George's Healthcare NHS Trust, London, United Kingdom; Cardiovascular Sciences, St Georges University of London, London, United Kingdom.
authors.forename: Nihil
authors.initials: N
authors.lastname: Chitalia
authors.forename: Louise
authors.initials: L
authors.lastname: Ross
authors.forename: Mahesh
authors.initials: M
authors.lastname: Krishnamoorthy
authors.forename: Alexander
authors.initials: A
authors.lastname: Kapustin
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Shanahan
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Kaski
authors.forename: Prabir
authors.initials: P
authors.lastname: Roy-Chaudhury
authors.forename: Eric
authors.initials: E
authors.lastname: Chemla
authors.forename: Debasish
authors.initials: D
authors.lastname: Banerjee
mesh_terms: D000328:Adult; D000368:Aged; D001916:Brachial Artery / Q000473:pathology; D005260:Female; D006801:Humans; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D058426:Neointima / Q000473:pathology; D017534:Radial Artery / Q000473:pathology; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000473:pathology*; D017539:Tunica Intima / Q000473:pathology*; D061205:Vascular Calcification / Q000209:etiology / Q000473:pathology*; D059289:Vascular Stiffness