Salt and water retention and calcium blockade in uremia.

London, Gérard M.; Marchais, Sylvain J.; Guérin, Alain P.; Mëtivier, Fabien; Safar, Michel E.; Fabiani, F; Froment, L

doi:10.1161/01.cir.82.1.105

Cited by 114 publications

(58 citation statements)

References 34 publications

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“…6,7 The intraobserver repeatability of aortic PWV measurements was 5.8Ϯ1% (meanϮSD). 10 The presence of arterial calcifications was evaluated ultrasonographically in the CCA, abdominal aorta, iliofemoral axis, and legs as previously described. 4 Highly echogenic plaques producing bright white echoes with shadowing were considered to be calcifications.…”

Section: Data Collectionmentioning

confidence: 99%

Arterial Calcifications, Arterial Stiffness, and Cardiovascular Risk in End-Stage Renal Disease

et al. 2001

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Abstract-To test the predictive values of and independent contributions to cardiovascular and all-cause mortality of various arterial parameters exploring characteristics of the arterial wall at different sites, we studied prospectively 110 stable end-stage renal disease patients on hemodialysis. These parameters involved carotid diameter, carotid intima-media thickness, carotid compliance, carotid distensibility, carotid incremental elastic modulus, aortic diameter, aortic pulse wave velocity, and the presence of arterial calcifications measured at the sites of the carotid artery, abdominal aorta, iliofemoral axis, and legs. The presence of calcifications was analyzed semiquantitatively as a score (0 to 4) according to the number of arterial sites with calcifications. During a follow-up of 53Ϯ21 months (meanϮSD), 25 cardiovascular and 14 noncardiovascular deaths occurred. In univariate analysis, the carotid incremental elastic modulus was the most closely related to prognosis. Risk of death increased with the number of vascular sites involved by calcifications. Moreover, information (in terms of prediction) given by carotid elastic incremental modulus was additive to the presence and extent of vascular calcification-related prediction value. Adjusted hazard ratios of all-cause and cardiovascular mortality for an increase of 1 unit in calcification score were 1.9 (95% confidence interval [CI], 1.4 to 2.6) and 2.6 (95% CI, 1.5 to 4.4), respectively (PϽ0.001 for both). Adjusted hazard ratios of all-cause and cardiovascular mortality for a 1-SD increase in carotid incremental elastic modulus were 1.6 (95% CI, 1.2 to 2.2) and 1.7 (95% CI, 1.2 to 2.4), respectively (PϽ0.01 for both). 4 It has recently been reported that the presence of vascular calcifications in end-stage renal disease (ESRD) patients was associated with increased stiffness of large, capacitive, elastic-type arteries like the aorta and common carotid artery (CCA). 4 Because CCA incremental elastic modulus (Einc) and aortic pulse wave velocity (PWV) were both identified as strong predictors of prognosis in ESRD patients 5,6 and because, to the best of our knowledge, no prospective study has reported associations between arterial calcifications and prognosis in ESRD populations, we designed this study to test the predictive value of various arterial parameters exploring characteristics of the arterial wall at different sites. These parameters involved CCA diameter, CCA intima-media thickness (IMT), CCA compliance, CCA distensibility, CCA Einc, aortic diameter, aortic PWV, and the presence of arterial calcifications measured at the sites of the CCA, abdominal aorta, iliofemoral axis, and legs. Subsequently, we examined whether these different parameters had independent contributions to CV and all-cause mortality. Methods PatientsPatients were eligible for inclusion if they (1) had been on hemodialysis for Ն3 months (81Ϯ79 months, meanϮSD), (2) had no clinical CV disease during the 6 months preceding entry, and (3) agreed to participate in the follow-up...

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Section: Data Collectionmentioning

confidence: 99%

Arterial Calcifications, Arterial Stiffness, and Cardiovascular Risk in End-Stage Renal Disease

et al. 2001

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“…As previously described, 25 two-dimensionally directed M-mode echocardiography was performed using a Roche Kontron RT 400 apparatus (Roche Lab, Nutley, N.J.), an IRREX ultrasonograph with a 2.25 MHz 27 Left ventricular ejection fraction was estimated by the Teicholz equation. 28 All echocardiographic records were read blindly by the same two observers.…”

Section: Echocardiographic Measurementsmentioning

confidence: 99%

Increased systolic pressure in chronic uremia. Role of arterial wave reflections.

London¹,

Guérin²,

Pannier³

et al. 1992

Hypertension

238

136

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To assess the role of arterial wave reflections in the mechanism of systolic hypertension and altered pulsatile arterial dynamics in patients with end-stage renal disease (ESRD), 79 ESRD patients were compared with 73 age-matched control subjects with normal renal function and similar mean blood pressure. Wave reflections were investigated from the carotid pulse contour recorded by applanation tonometry using a Millar micromanometer-tipped probe. Wave reflections were quantified as the ratio (augmentation index, %) of the height of the late systolic peak to the total height of carotid pulse wave. Travel time of the reflected wave was timed from the foot of the pressure wave to the foot of the late systolic peak. Systolic and pulse pressure were increased in ESRD patients (p<0.001) and was not attributable to differences in left ventricular ejection pattern. The augmentation index was increased in ESRD patients (23.2 ±15.0 versus 9.8±15.6%;/><0.001) in association with a shorter travel time of reflected wave (109±24 versus 131 ±30 msec; p<0.001). Multiple regression analysis showed two principal factors associated (p<0.001) with the increase in augmentation index and shortened travel time of reflected wave: increased aortic pulse wave velocity and smaller stature with shorter body height in ESRD patients. The study points to the mle of arterial wave reflections in the mechanisms producing alterations in pulsatile arterial dynamics in ESRD and is the first, through the mechanisms of early wave reflections, to show in humans that the increase in systolic and pulse pressures is associated with lesser body size. (Hypertension

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“…7 We have previously shown that interdialytic weight gain, a classic marker of sodium and water overload, is strongly associated with increased aortic PWV, independently of BP levels. 8 However, in chronic renal failure, there are many other nonmechanical factors that may be related to the status of large arteries.…”

mentioning

confidence: 95%

Influence of Biochemical Alterations on Arterial Stiffness in Patients With End-stage Renal Disease

Blacher

Demuth

Guérin

et al. 1998

ATVB

190

115

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Abstract-The incremental elastic modulus of the common carotid and radial arteries is increased in patients with end-stage renal disease (ESRD), independently of blood pressure, wall stress, and the presence of atherosclerotic alterations. Whether biochemical factors may be involved in the arterial changes and related to renal dysfunction remain largely ignored. To assess this question, we measured aortic (carotid-femoral), upper-limb (carotid-radial), and lower-limb (femoral-tibial) pulse wave velocity (PWV) in 74 ESRD patients undergoing hemodialysis in comparison with 57 control subjects similar in age, sex ratio, and mean blood pressure. We evaluated arterial blood presure by sphygmomanometry, aortic calcifications and cardiac mass by echography, and routine biochemical parameters, total plasma homocysteine, and plasma endothelin levels by standard techniques. In the population of patients with ESRD, on the basis of multiple stepwise regression analysis, aortic PWV was positively and independently correlated with systolic blood pressure (PϽ.0001), age (PϽ.0001), prevalence of aortic calcification (Pϭ.0004), and the prevalence of diabetes mellitus (Pϭ.0043). Upper-limb PWV was influenced exclusively by mean blood pressure (PϽ.0001). Lower-limb PWV was positively and independently correlated with plasma total homocysteine (Pϭ.0004) and plasma endothelin (Pϭ.0187) only. At any vascular site, PWV was not independently correlated with tobacco consumption; plasma levels of cholesterol, triglyceride, fibrinogen, or hemoglobin; body mass index; or the presence of bilateral nephrectomy. Finally, plasma homocysteine was independently correlated with cardiac mass (Pϭ.0022). This study provides evidence that in ESRD patients, the stiffness of the arterial wall and cardiac mass are strongly influenced by biochemical factors related to the kidney alterations and are independent of age and blood pressure level. Increased plasma endothelin and homocysteine may be specifically involved in the vascular damage of lower limbs. (Arterioscler Thromb Vasc Biol. 1998;18:535-541.)

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Salt and water retention and calcium blockade in uremia.

Cited by 114 publications

References 34 publications

Arterial Calcifications, Arterial Stiffness, and Cardiovascular Risk in End-Stage Renal Disease

Arterial Calcifications, Arterial Stiffness, and Cardiovascular Risk in End-Stage Renal Disease

Increased systolic pressure in chronic uremia. Role of arterial wave reflections.

Influence of Biochemical Alterations on Arterial Stiffness in Patients With End-stage Renal Disease

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