SP565ARTERIAL STIFFNESS AND CHRONIC KIDNEY DISEASE-MINERAL BONE DISORDER (CKD-MBD) IN HEMODIALYSED PATIENTS

Abstract

INTRODUCTION: Arterial stiffness is reported to be a predictor of mortality in hemodialysis patients, and there is also data regarding the association of circulating angiogenic factors, such as vascular endothelial growth factor (VEGF) with chronic kidney disease. The purpose of this study was to assess the potential relationship of arterial stiffness with elements of CKD-MBD, with markers of cardiovascular disease and with VEGF. METHODS: We conducted a single-center cross-sectional study that included 63 CKD G5D patients (hemodialysis for 1-5 years, mean age 60.1+/- 11.8 years). All patients have been assessed regarding cardiovascular disease (medical history, echocardiography and ECG), we performed using standard methods blood biochemistry, complete blood count and using an enzyme- linked immunosorbent assay method- VEGF, soluble klotho. In every patient we measured aortic augmentation index (AAI) and brachial pulse wave velocity (PWV), using oscillometry. RESULTS: In the studied patients we found a mean value of PWV of 9.3 +/-1.8 m/s. PWV showed a positive correlation with age (r=0.38, p=0.009). We have also found a statistically significant correlation between PWV and serum calcium (r=0.53, p=0.0003) and serum phosphate (r=0.38, p=009), but there was however no statistically significant correlation with iPTH, alkaline phosphatase, vitamin D, soluble klotho. Arterial stiffness results, expressed using PWV showed no differences between the subgroups of patients with/ without diabetes mellitus, valvular calcification, left ventricular hypertrophy, signs of ischemia on ECG. Regarding serum VEGF (mean value 137.13+/- 78.74 pg/ml), with higher values in patients with diabetes (154.2 vs 122.8, not statistically significant). We found no statistically significant correlation of VEGF with arterial stiffness. On the other hand, we found a positive, statistically significant correlation, between PWV and hemoglobin (r=0.48, p=0.001) and with serum albumin (r=0.53, p=0.0003). With regard to dialysis efficiency we found a surprising positive statistically significant correlation between eKT/V and PWV (r=0.36, p=0.01), and also with dialysis blood flow (r=0.49, p=0.0007). It has to be mentioned that we observed an increase of eKT/V with the dialysis vintage (r=0.31, p=0.01) CONCLUSIONS: These data indicate an increase of arterial stiffness with age and an association with elements of CKD-MBD. We found also a positive correlation with serum albumin and hemoglobin. However, our study could not show a relationship of arterial stiffness with markers of cardiovascular disease or with circulating angiogenic factors. Further studies are needed to examine the role of angiogenic factors in CKD.