Coronary flow velocity reserve and inflammatory markers in living kidney donors

Abstract

Background Coronary microvascular dysfunction is prevalent in chronic kidney disease (CKD), and may contribute to the development of myocardial dysfunction in CKD. Coronary flow velocity reserve (CFVR) is a marker of coronary microvascular function and falls with increasing CKD stage. Living kidney donors have renal function consistent with early stage CKD and concern has been raised about their cardiovascular risk. No studies to date have investigated the presence of coronary microvascular dysfunction in living kidney donors. Methods 25 healthy controls and 23 living kidney donors were recruited and underwent assessment with transthoracic echocardiography, Doppler CFVR, myocardial contrast echocardiography and serum multiplex immunoassay panels. Results Doppler CFVR was significantly reduced in living kidney donors compared to controls (mean CFVR 3.4 ± 0.7 vs 3.8 ± 0.6, mean difference 0.4 95% confidence interval 0.03–0.8, p =.036). Quantitative myocardial contrast echocardiography showed a trend towards reduced coronary flow reserve in living kidney donors. Compared to controls, living kidney donors had higher serum high sensitivity C reactive peptide (hsCRP) and lower levels of uromodulin. Conclusions This is the first study of CFVR in living kidney donors. We have shown that the modest drop in estimated glomerular filtration rate in living kidney donors is associated with lower values of Doppler CFVR compared to controls, suggesting that isolated reductions in renal function may lead to altered microvascular function. The increase in hsCRP and reduction in uromodulin suggests that chronic subclinical inflammation may contribute to altered microvascular function in this population.

Coronary microvascular dysfunction is associated with degree of anaemia in end‐stage renal disease

“…Mean CFVR for subjects without CMD was 3.2 ± 0.9. Previously published data by our group demonstrated a reference value of CFVR in healthy controls of 3.8 ± 0.6 [ 13 ]. Baseline demographic, laboratory and haemodynamic data for subjects with and without CMD are shown in Table 1 .…”

“…Doppler CFVR assessment was performed as previously described [ 13 ]. The left anterior descending artery (LAD) was identified on colour Doppler in the anterior inter-ventricular sulcus.…”

“…Myocardial contrast echocardiography was performed as previously described [ 13 ]. Images were taken in the 3 apical views using low-power continuous MCE at a mechanical index (MI) of 0.1.…”

Screening for occult coronary artery disease in potential kidney transplant recipients: time for reappraisal?

“…The sensitivity and specificity of MPS and DSE are lower in patients with kidney failure than in patients without CKD. False-negative results are more likely, probably because coronary flow reserve is impaired [ 34 ] and there is a high prevalence of multivessel coronary artery disease with balanced ischaemia [ 35 ]. False-positive results are also more likely because of increased left ventricular mass, concentric remodelling and increased afterload [ 35–37 ].…”

The kidney releases a non-polymerizing form of Uromodulin in the urine and circulation that retains the external hydrophobic patch domain

“…A growing body of compelling evidence suggests that the presence of high levels of THP (in the urine or serum) is independently associated with reduced risk of incident acute and chronic kidney disease, kidney disease progression, cardiovascular disease and mortality outcomes (8, 26-34). In addition, THP serum levels are inversely correlated with markers of systemic inflammation (35, 36).…”