Premature Aging of the Microcirculation in Patients with Advanced Chronic Kidney Disease

Abstract

Background: Increasing age and advanced chronic kidney disease (CKD) are both associated with an attenuated vasodilator response of the skin microcirculation. In the present study, we investigated the effect of aging on microvascular reactivity in patients with advanced CKD. Methods: Acetylcholine (ACh)-mediated endothelium-dependent vasodilation and sodium nitroprusside (SNP)-mediated endothelium-independent vasodilation were assessed by iontophoresis combined with laser Doppler flowmetry. Microvascular function was compared between 52 patients with advanced CKD (stage 4–5: n = 16; end-stage renal disease: n = 36) and 33 healthy control subjects. As aging has an important effect on microvascular function, both control subjects and CKD patients were divided in subgroups younger and older than 45 years. Linear regression analysis was applied to assess potential associations between microvascular function and various demographic and clinical parameters. Results: There were three main findings. (1) In young patients with advanced CKD, both ACh- and SNP-mediated vasodilations were impaired if compared to young healthy controls (p = 0.04 and p = 0.056, respectively). (2) In young patients with advanced CKD, microvascular function was similar to old healthy controls and elderly patients with advanced CKD. (3) Whereas age was inversely associated with microvascular function in healthy controls (log ACh-mediated vasodilation R = –0.41; p = 0.02 and log SNP-mediated vasodilation R = –0.38; p = 0.03), no such relation was found in patients with advanced CKD. Conclusions: Our results are consistent with premature aging of the microvascular vasodilatory capacity in patients with advanced CKD.

Early retinal microvascular abnormalities in patients with chronic kidney disease

“…26 Chronic kidney disease may also contribute to premature aging of microcirculation. 27 Diabetes mellitus was present in 91 (45.5%) patients in the current study. It had been well known that the reduction of vessel density is correlated to the severity of diabetic retinopathy.…”

“…A prior OCTA study has demonstrated that aging is associated with decreased vessel density in both the superficial and deep capillary plexus in the normal population . Chronic kidney disease may also contribute to premature aging of microcirculation . Diabetes mellitus was present in 91 (45.5%) patients in the current study.…”

Relationships Between Type 2 Diabetes, Neuropathy, and Microvascular Dysfunction: Evidence From Patients With Cryptogenic Axonal Polyneuropathy

“…However, the difference that we found between patients with diabetes versus HCs and patients with CAP is similar to an observation we made in the past. We repeatedly demonstrated a reduction in ACh-mediated vasodilatory response of approximately 300 to 400% points in several disease entities: hypertension (33), chronic kidney disease (34), and systemic sclerosis (35). We defined such a reduction as clinically relevant.…”

Evaluation of microvascular reactivity with laser Doppler flowmetry in chronic kidney disease

“…Data in patients with CKD are controversial. Thang et al [46] found that Ach and SNP iontophoresis provoked vasodilatation was altered in patients with advanced CKD compared to healthy controls. In contrast, Cupisti et al [47] found no alternations in the hyperaemic response after Ach and SNP iontophoresis in patients with CKD compared to healthy controls.…”