Key result
Glomerular CKD is linked to ~32% lower arterial stiffness versus hypertensive or diabetic CKD.
Why the study?
It remained unclear whether hypertensive and diabetic CKD or CKD secondary to immune-mediated glomerulonephritis contributes more to accelerated arterial stiffness and early vascular aging.
Does CKD secondary to glomerular disorders result in lower arterial stiffness compared to hypertensive and diabetic CKD in patients with chronic kidney disease?
Observational (n=56)
No
Does CKD secondary to glomerular disorders result in lower arterial stiffness compared to hypertensive and diabetic CKD in patients with chronic kidney disease?
CKD secondary to immune-mediated glomerulonephritis is associated with significantly lower arterial stiffness compared to CKD caused by hypertension and diabetes, suggesting different mechanisms of vascular aging.
Answers are grounded in this paper and cite their sources.
Glomerular CKD-linked lower PWV should not yet change practice; leaves open etiology-specific vascular aging mechanisms.
Background Chronic kidney disease (CKD) manifested as reduced GFR and/or albuminuria, has been known to accelerate arterial stiffness and early vascular aging (EVA). Diabetes, hypertension, and glomerular disorders are the leading causes of CKD and renal failure. The question which etiology contributes more to this vascular phenomenon-hypertensive and diabetic CKD or CKD secondary to immune-mediated glomerulonephritis—remained unclear. Objective To compare pulse wave velocity (PWV), a marker of arterial stiffness, between CKD patients of different etiologies: hypertensive and diabetic nephrosclerosis. vs. CKD secondary to glomerular disorders. Methods Clinical data were collected on 56 patients followed at the Nephrology and Hypertension Institute in Samson Assuta Ashdod University Hospital. All patients had at least one visit at our Nephrology clinics prior to recruitment. All patients with a glomerular disorder had a clinical-pathological diagnosis based on a recent kidney biopsy. Pulse wave velocity (PWV) was measured using a validated Sphygmocor XCEL ® device. Univariate and multivariate analyses were performed to compare PWV between hypertensive/diabetic CKD and CKD secondary to glomerular disorders. Results PWV was significantly higher in the hypertensive/diabetic CKD group, compared to the CKD-GN group, with an average of. 12.2 m/s vs 8.3 m/s, respectively (p < 0.001). In a multivariate linear regression model, having CKD secondary to glomerulonephritis was associated with a significantly lower PWV (B = − 3.262, p < 0.001), compared with CKD secondary to hypertension and diabetes, with adjustment of age, creatinine, and comorbidities. Conclusion CKD Patients secondary to glomerulonephritis, have lower PWV when compared to CKD patients with diabetes and/or hypertension, even after adjusting for age, renal function, and the presence of comorbidities. It is intriguing to further study the possible protective role of immunosuppression on the arterial properties of CKD patients.
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Lencovsky et al. (2023) conducted an observational in Chronic Kidney Disease (CKD) (n=56). CKD secondary to glomerular disorders (CKD-GN) vs. CKD secondary to hypertension and/or diabetes (CKD-HTN/DM) was evaluated on Pulse wave velocity (PWV) (B -3.262, 95% CI -5.531 to -0.993, p=<0.001). Patients with CKD secondary to glomerular disorders had significantly lower arterial stiffness compared to those with hypertensive or diabetic CKD (median pulse wave velocity 8.3 vs 12.2 m/s).
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