Chronic Kidney Disease

Zuo’s team investigated the correlation of various vascular phenotypes, such as arterial stiffness and blood pressure status, and target organ damage. The results found that patients exhibiting both elevated pulse wave velocity (PWV) and central blood pressure (CBP) face heightened risks of chronic kidney disease (CKD). Notably, individuals with solely elevated CBP display an increased risk of abnormal albumin-to-creatinine ratio (ACR), signifying early stages of renal impairment. This suggests that elevation of central aortic blood pressure, distinct from PWV, may serve as an early indicator of renal impairment. 

Left ventricular hypertrophy (LVH) is a common cardiovascular complication of chronic kidney disease (CKD), closely associated with increased cardiovascular morbidity and mortality. Ruyi Cai and colleagues demonstrated that even within a CKD population, Central pulse pressure exhibited higher sensitivity and specificity compared to brachial pulse pressure for determining LVH. The study’s findings indicate that CBP serves as a superior predictor of LVH risk. Advocating for early identification and treatment of elevated CBP mitigates the risk of LVH and subsequent cardiovascular complications in CKD patients.

Most pharmacologic interventions that target aortic stiffness in renal disease are associated with mixed effects to vascular function. A team led by Agharazii conducted a meta-analysis to determine which targeted aortic stiffness therapies improve PWV and SBP measures. Multiple therapies, vitamin D and renin angiotensin system inhibitors, did not show any added benefit than placebo groups. However, calcium channel blockers showed a controlled decrease of both PWV and SBP beyond standard care. This indicates that incorporating this therapy could have reduced cardiovascular burden within renal affected cohorts. 

Vitamin D deficiency is linked to chronic kidney disease (CKD) progression and vascular dysfunction. Dou and colleagues conducted a meta-analysis of seven randomized controlled trials involving 429 CKD patients. Results showed that Vitamin D treatment correlated with a significant decrease in pulse wave velocity, indicating reduced arterial stiffness. Interestingly, no significant differences in blood pressure were observed. Therefore, these findings suggest that vitamin D supplementation may improve vascular health by reducing arterial stiffness, independent of blood pressure changes.

In individuals with severely dysfunction kidneys, hemodialysis enables filtration of blood but in turn it significantly increases cardiovascular burden. Debowska and colleagues found that pulse wave analysis features (systolic, augmented and pulse pressure) were significantly different at the end of dialysis. The subendocardial viability ratio (SEVR) was strongly correlated with hydration levels during hemodialysis. The estimation of SEVR from the aortic waveform specifically helps inform fluid management during treatment to maintain cardiac function. Pulse-wave analysis parameters are easily measurable and accessible which monitor sudden cardiovascular changes which can help prevent overhydration during hemodialysis treatment. 

The team led by Laurent investigated the correlation between vascular function and cognitive decline in chronic kidney disease (CKD) patients. The findings suggest that both arterial stiffness (cf-PWV), and central pulse pressure are elevated in CKD patients with known cognitive decline, as assessed by the Mini-Mental State Examination (MMSE). The observed correlation of vascular health with both brain function and CKD proposes that patients may experience parallel deterioration. Early detection of elevated central pulse pressure and arterial stiffening could help not only identify risk of CKD but also help mitigate cognitive decline and improve overall outcomes.

Patients with resistant hypertension have heightened blood pressure despite using antihypertensive drugs. Venioles’s team investigated the effects of different additional therapies, renal denervation or antihypertensive, in participants with resistant hypertension on existing diuretic treatment. Central pulse pressure was significantly decreased within the antihypertensive group indicating that including additional targeted hypertensive therapy in combination with existing treatment could help mitigate target organ damage in resistant hypertensive.