Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.200245
Jornal Vascular Brasileiro
Original Article

The association between Hba1c and arterial stiffness among non-diabetic patients with chronic kidney disease

Associação entre Hba1c e rigidez arterial entre pacientes sem diabetes com doença renal crônica

Atakan Turgutkaya; Gülay Aşçı

http://dx.doi.org/10.1590/1677-5449.200245 J Vasc Bras, vol.20, e20200245, 2021
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Abstract

Abstract: Background: Cardiovascular events are seen more frequently after the age of 60 and they are a significant cause of morbidity and mortality. Arterial stiffness is a property that can be expressed by pulse wave velocity and this value is assumed to be a predictor of cardiovascular events. Patients with chronic kidney disease and dysregulated blood sugar have increased atherosclerosis and arterial stiffness, but the relationship between physiological levels of Hba1c and arterial stiffness is less clear in chronic kidney disease patients without diabetes mellitus.

Objectives: Here, we aimed to investigate the degree of arterial stiffness among non-diabetic, non-dialysis dependent chronic kidney disease patients with physiological HbA1c levels.

Methods: We enrolled 51 patients who were followed up at Ege University Hospital Nephrology Department between February and June 2015. Non-diabetic, non-dialysis dependent chronic kidney disease patients were included in the study. Blood pressure and pulse wave velocity were measured with an applanation tonometry device (Sphygmocor Vx Software Atcor Medical, Australia). Correlations between pulse wave velocity and the aforementioned parameters were investigated (see below).

Results: We detected a significant correlation between pulse wave velocity and systolic blood pressure (p=0.0001) and Hba1c (p=0.044) separately. There was an inverse correlation with creatinine clearance (p=0.04). We also detected a significant correlation with serum phosphorus level (p=0.0077) and furosemide use (p=0.014). No correlations were found among the other parameters.

Conclusions: Arterial stiffness is an important predictor of cardiovascular events and measuring it is an inexpensive method for estimating morbidity and mortality. Our study supports the importance of measuring arterial stiffness and of controlling blood glucose levels, even at physiological Hba1c values, especially for chronic kidney disease patients.

Keywords

arterial stiffness, atherosclerosis, cardiovascular, chronic kidney disease, pulse wave velocity

Resumo

Resumo: Contexto: Os eventos cardiovasculares são mais frequentes em pessoas com mais de 60 anos, e sugere-se que sejam causas significativas de morbidade e mortalidade. A rigidez arterial é expressa pela velocidade da onda de pulso, e presume-se que esse valor seja um preditor de eventos cardiovasculares. Os pacientes com doença renal crônica e desregulação do açúcar no sangue têm aterosclerose e rigidez arterial aumentadas. No entanto, a relação entre os níveis fisiológicos de Hba1c e a rigidez arterial entre pacientes com doença renal crônica sem diabetes melito é menos clara.

Objetivos: Buscamos investigar o grau de rigidez entre os pacientes sem diabetes e portadores de doença renal crônica sem dependência de diálise com níveis fisiológicos de HbA1c.

Métodos: Incluímos 51 pacientes, sem diabetes e com doença renal crônica sem dependência de diálise, que estavam em acompanhamento no Departamento de Nefrologia do Ege University Hospital entre fevereiro e junho de 2015. A pressão sanguínea e a velocidade da onda do pulso foram medidas com um dispositivo de tonometria de aplanação (Sphygmocor Vx Software Atcor Medical, Austrália). A correlação entre a velocidade da onda de pulso e os parâmetros mencionados anteriormente foi investigada.

Resultados: Detectamos correlação significativa entre a velocidade da onda de pulso e a pressão arterial sistólica (p = 0,0001) e Hba1c (p = 0,044) separadamente. Foi constatada correlação inversa com a depuração de creatinina (p = 0,04). Também detectamos correlação significativa com o nível de fósforo sérico (p = 0,0077) e o uso de furosemida (p = 0,014). Não foi encontrada correlação entre outros parâmetros.

Conclusões: A rigidez arterial é um preditor importante de eventos cardiovasculares, e a sua medição é um método de baixo custo para estimar a morbidade e mortalidade. Nosso estudo corrobora a importância da medição da rigidez arterial e do controle dos níveis de glicemia sanguínea mesmo em valores de Hba1c fisiológicos, principalmente para pacientes portadores de doença renal crônica.
 

Palavras-chave

rigidez arterial, aterosclerose, cardiovascular, doença renal crônica, velocidade da onda de pulso

References

1 Briet M, Boutouyrie P, Laurent S, London GM. Arterial stiffness and pulse pressure in CKD and ESRD. Kidney Int. 2012;82(4):388-400. http://dx.doi.org/10.1038/ki.2012.131. PMid:22534962.

2 Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol. 2010;55(13):1318-27. http://dx.doi.org/10.1016/j.jacc.2009.10.061. PMid:20338492.

3 London GM. Arterial stiffness in chronic kidney disease and end-stage renal disease. Blood Purif. 2018;45(1-3):154-8. http://dx.doi.org/10.1159/000485146. PMid:29478047.

4 Prenner SB, Chirinos JA. Arterial stiffness in diabetes mellitus. Atherosclerosis. 2015;238(2):370-9. http://dx.doi.org/10.1016/j.atherosclerosis.2014.12.023. PMid:25558032.

5 Dumor K, Shoemaker-Moyle M, Nistala R, Whaley-Connell A. Arterial stiffness in hypertension: an update. Curr Hypertens Rep. 2018;20(8):72. http://dx.doi.org/10.1007/s11906-018-0867-x. PMid:29974262.

6 Chan DT, Watts GF, Irish AB, Ooi EMM, Dogra GK. Insulin resistance and the metabolic syndrome are associated with arterial stiffness in patients with chronic kidney disease. Am J Hypertens. 2013;26(9):1155-61. http://dx.doi.org/10.1093/ajh/hpt077. PMid:23736110.

7 Chen TK, Knicely DH, Grams ME. Chronic kidney disease diagnosis and management: a review. JAMA. 2019;322(13):1294-304. http://dx.doi.org/10.1001/jama.2019.14745. PMid:31573641.

8 Butlin M, Qasem A. Large artery stiffness assessment using sphygmocor technology. Pulse. 2017;4(4):180-92. http://dx.doi.org/10.1159/000452448. PMid:28229053.

9 The Diabetes Control and Complications Trial Research Group. The effect of intensive diabetes therapy on the development and progression of neuropathy. Ann Intern Med. 1995;122(8):561-8. http://dx.doi.org/10.7326/0003-4819-122-8-199504150-00001. PMid:7887548.

10 Dickinson KM, Clifton PM, Burrell LM, Barrett PHR, Keogh JB. Postprandial effects of a high salt meal on serum sodium, arterial stiffness, markers of nitric oxide production and markers of endothelial function. Atherosclerosis. 2014;232(1):211-6. http://dx.doi.org/10.1016/j.atherosclerosis.2013.10.032. PMid:24401240.

11 Aroor AR, Jia G, Sowers JR. Cellular mechanisms underlying obesity-induced arterial stiffness. Am J Physiol Regul Integr Comp Physiol. 2018;314(3):R387-98. http://dx.doi.org/10.1152/ajpregu.00235.2016. PMid:29167167.

12 Zambanini A, Cunningham SL, Parker KH, Khir AW, McG-Thom SA, Hughes AD. Wave-energy patterns in carotid, brachial, and radial arteries: a noninvasive approach using wave-intensity analysis. Am J Physiol Heart Circ Physiol. 2005;289(1):270-6. http://dx.doi.org/10.1152/ajpheart.00636.2003.

13 Palombo C, Kozakova M. Arterial stiffness, atherosclerosis, and cardiovascular risk: pathophysiologic mechanisms and emerging clinical indications. Vascul Pharmacol. 2016;77:1-7. http://dx.doi.org/10.1016/j.vph.2015.11.083. PMid:26643779.

14 Erdan A, Ozkok A, Alpay N, Akkaya V, Yıldız A. Volume status and arterial blood pressures are associated with arterial stiffness in hemodialysis patients. Int J Artif Organs. 2018;41(7):378-84. http://dx.doi.org/10.1177/0391398818778212. PMid:29806514.

15 Bosworth C, Sachs MC, Duprez D, et al. Parathyroid hormone and arterial dysfunction in the multi-ethnic study of atherosclerosis. Clin Endocrinol. 2013;79(3):429-36. http://dx.doi.org/10.1111/cen.12163. PMid:23402353.

16 Lishmanov A, Dorairajan S, Pak Y, Chaudhary K, Chockalingam A. Elevated serum parathyroid hormone is a cardiovascular risk factor in moderate chronic kidney disease. Int Urol Nephrol. 2012;44(2):541-7. http://dx.doi.org/10.1007/s11255-010-9897-2. PMid:21327525.

17 Bhuriya R, Li S, Chen SC, McCullough PA, Bakris GL. Plasma parathyroid hormone level and prevalent cardiovascular disease in ckd stages 3 and 4: an analysis from the Kidney Early Evaluation Program (KEEP). Am J Kidney Dis. 2009;53(4, Suppl 4):S3-10. http://dx.doi.org/10.1053/j.ajkd.2008.11.029. PMid:19285609.

18 Cavero-Redondo I, Martínez-Vizcaíno V, Álvarez-Bueno C, Recio-Rodríguez JI, Gómez-Marcos MÁ, García-Ortiz L. Relationship between glycaemic levels and arterial stiffness in non-diabetic adults. Med Clin. 2018;150(2):56-60. http://dx.doi.org/10.1016/j.medcli.2017.06.072. PMid:28923672.

19 Zeng Q, Dong SY, Wang ML, et al. Serum glycated albumin, glycated hemoglobin, and arterial stiffness in a general Chinese population. Clin Chim Acta. 2017;468:33-8. http://dx.doi.org/10.1016/j.cca.2017.02.002. PMid:28163034.

20 Kim M, Kim M, Yoo HJ, Lee SY, Lee SH, Lee JH. Age-specific determinants of pulse wave velocity among metabolic syndrome components, inflammatory markers, and oxidative stress. J Atheroscler Thromb. 2018;25(2):178-85. http://dx.doi.org/10.5551/jat.39388. PMid:28740031.

21 Kuo CF, Yu KH, Luo SF, et al. Role of uric acid in the link between arterial stiffness and cardiac hypertrophy: a cross-sectional study. Rheumatology. 2010;49(6):1189-96. http://dx.doi.org/10.1093/rheumatology/keq095. PMid:20371503.

22 Lovic D, Kallistratos MS, Poulimenos L, et al. Pulse wave velocity: retrospective analysis in a balkan normotensive and hypertensive population: a study of 9923 patients. Angiology. 2018;69(1):59-64. http://dx.doi.org/10.1177/0003319717709859. PMid:28514871.

23 Kim ED, Tanaka H, Ballew SH, et al. Associations between kidney disease measures and regional pulse wave velocity in a large community-based cohort: the Atherosclerosis Risk in Communities (ARIC) study. Am J Kidney Dis. 2018;72(5):682-90. http://dx.doi.org/10.1053/j.ajkd.2018.04.018. PMid:30007506.

24 Grigoropoulou P, Tentolouris A, Eleftheriadou I, et al. Effect of 12-month intervention with low-dose atorvastatin on pulse wave velocity in subjects with Type 2 diabetes and dyslipidaemia. Diab Vasc Dis Res. 2019;16(1):38-46. http://dx.doi.org/10.1177/1479164118805320. PMid:30328360.

25 Tatar E, Demirci MS, Kircelli F, et al. Association of Insulin Resistance with Arterial Stiffness in Nondiabetic Peritoneal Dialysis Patients. Int Urol Nephrol. 2012;44(1):255-62. http://dx.doi.org/10.1007/s11255-011-9984-z. PMid:21643643.

26 Bajaj S, Das AK, Kalra S, et al. BE-SMART (Basal Early Strategies to Maximize HbA1c Reduction with Oral Therapy): expert opinion. Diabetes Ther. 2019;10(4):1189-204. http://dx.doi.org/10.1007/s13300-019-0629-z. PMid:31102253.
 

Submitted date:
01/11/2021

Accepted date:
03/15/2021

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
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