What is the clinical evidence from this study?

Study design: Observational. Population: Cardiovascular risk factors (n=341). Intervention: Flow-mediated dilation (FMD). Primary outcome: eGFR slope (p=<0.001).

April 18, 2023Open Access

Vascular Endothelial Function Is Associated with eGFR Slope in Female and Non-Smoking Male Individuals with Cardiovascular Risk Factors: A Pilot Study on the Predictive Value of FMD for Renal Prognosis

Q: What are the key findings of this study?

Higher baseline flow-mediated dilation values were independently associated with a better preserved eGFR slope over 24 months in females (p<0.001) and non-smoking males (p=0.045) with cardiovascular risk factors.

Key Result

Higher baseline flow-mediated dilation values were independently associated with a better preserved eGFR slope over 24 months in females (p<0.001) and non-smoking males (p=0.045) with cardiovascular risk factors.

Study Design

Type

Observational (n=341)

Multicenter

Yes

Structured PICO

Does vascular endothelial function assessed by FMD predict longitudinal eGFR changes in patients with cardiovascular risk factors?

Population

341 patients (176 males and 165 females) with cardiovascular risk factors

Intervention

Vascular function assessment by flow-mediated dilation (FMD) and brachial-ankle pulse wave velocity (baPWV)

Outcome

24-month longitudinal eGFR changes (eGFR slope)surrogate

Flow-mediated dilation (FMD) is a useful predictor of renal prognosis (eGFR decline) in females and non-smoking males with cardiovascular risk factors.

Main Result

p-value: p=<0.001

Limitations

Retrospective observational study design cannot confirm causation
Small sample size limits detailed mechanistic analysis
Smoking status data lacked pack-years information, potentially underestimating smoking status
Small number of female current smokers
Other critical comorbidities such as coronary artery disease, stroke, and peripheral arterial diseases were not analyzed
Findings cannot be generalized to the general population
Sample size was too small to identify rapid eGFR decliners in logistic regression analysis
Unclear whether interventions for amelioration of FMD improve renal prognosis in clinical practice

Abstract

AIMS: It is known that there are sex differences in vascular endothelial function and the development of chronic kidney diseases; however, it remains unclear whether sex differences influence the association between vascular endothelial function and renal prognosis. METHODS: To clarify the relationship between vascular endothelial function and longitudinal eGFR changes in male and female patients with cardiovascular risk factors, we retrospectively evaluated 341 patients (176 males and 165 females) with cardiovascular risk factors in whom vascular function was assessed by flow-mediated dilation (FMD) and brachial-ankle pulse wave velocity (baPWV) and in whom 24-month longitudinal eGFR values were recorded after the vascular function examinations. Associations of values of FMD and baPWV with values of eGFR slope were statistically analyzed. RESULTS: Simple regression analysis showed that the value of FMD was positively associated with eGFR slope in females (p=0.001) and non-smoking males (p=0.033) but not in smoking males. Multiple regression analysis showed that the value of FMD remains a positive contributor for eGFR slope in females (p=0.001) and non-smoking males (p=0.045) but not in smoking males. In contrast, values of baPWV had no significant association with eGFR slope regardless of sex and cigarette smoking. CONCLUSIONS: In individuals with cardiovascular risk factors, evaluation of vascular endothelial function enables prediction of renal prognosis in females and non-smoking males.

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