title: Microvascular endothelial dysfunction is associated with albuminuria and CKD in older adults.
abstract: Impairment in glomerular endothelial function likely plays a major role in the development of albuminuria and CKD progression. Glomerular endothelial dysfunction may reflect systemic microvascular dysfunction, accounting in part for the greater cardiovascular risk in patients with albuminuria. Prior studies of vascular function in CKD have focused on conduit artery function or those with ESRD, and have not examined microvascular endothelial function with albuminuria.
  
  
  
  We conducted a cross-sectional study among older hypertensive male veterans with stage 1-4 CKD, and hypertensive controls without CKD. Microvascular function was quantified by two distinct Laser-Doppler flowmetry (LDF) measures: peak responses to 1) post-occlusive reactive hyperemia (PORH) and 2) thermal hyperemia (TH), measured on forearm skin. Associations of each LDF measure with albuminuria, eGFR, and CKD status were estimated using correlation coefficients and multiple linear regression, accounting for potential confounders.
  
  
  
  Among 66 participants (mean age 69.2 years), 36 had CKD (mean eGFR 46.1 cc/min/1.73 m(2); 30.6 % with overt albuminuria). LDF responses to PORH and TH were 43 and 39 % significantly lower in multivariate analyses among those with macroalbuminuria compared to normoalbuminuria, (β= - 0.42, p = 0.009 and β= -0.37, p = 0.01, respectively). Those with CKD had a 23.9 % lower response to PORH compared to controls (p = 0.02 after adjustment). In contrast, TH responses did not differ between those with and without CKD.
  
  
  
  Microvascular endothelial function was strongly associated with greater albuminuria and CKD, independent of diabetes and blood pressure. These findings may explain in part the excess systemic cardiovascular risk associated with albuminuria and CKD.
authors.affiliation: Department of Medicine, University of Maryland School of Medicine, 22 S. Greene Street, Room N3W143, Baltimore, MD, 21201, USA. sseliger@medicine.umaryland.edu.|Medicine, VA Maryland Healthcare System, Baltimore, USA. sseliger@medicine.umaryland.edu.
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Seliger
authors.affiliation: Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA.
authors.forename: Shabnam
authors.initials: S
authors.lastname: Salimi
authors.affiliation: Creighton University School of Medicine, Omaha, USA.
authors.forename: Valerie
authors.initials: V
authors.lastname: Pierre
authors.affiliation: GRECC, VA Maryland Healthcare System, Baltimore, USA.
authors.forename: Jamie
authors.initials: J
authors.lastname: Giffuni
authors.affiliation: Department of Medicine, University of Maryland School of Medicine, 22 S. Greene Street, Room N3W143, Baltimore, MD, 21201, USA.|GRECC, VA Maryland Healthcare System, Baltimore, USA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Katzel
authors.affiliation: Department of Medicine, University of Maryland School of Medicine, 22 S. Greene Street, Room N3W143, Baltimore, MD, 21201, USA.|Medicine, VA Maryland Healthcare System, Baltimore, USA.
authors.forename: Afshin
authors.initials: A
authors.lastname: Parsa
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D001783:Blood Flow Velocity / Q000502:physiology; D003430:Cross-Sectional Studies; D004730:Endothelium, Vascular / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D008297:Male; D008833:Microcirculation / Q000502:physiology; D055806:Microvessels / Q000503:physiopathology*; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D012307:Risk Factors
keywords: Albuminuria; Blood pressure; CKD; Endothelial function; Laser Doppler flowmetry; Vascular disease