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Pulse wave velocity differs between ulcerative colitis and chronic kidney disease

Published:August 19, 2017DOI:https://doi.org/10.1016/j.ejim.2017.08.020

      Highlights

      • CKD and UC are characterized by different arterial phenotypes.
      • In patients with UC, the stiffness of both elastic and muscular arteries is increased.
      • In patients with CKD, the stiffness mismatch starts early, from stage 3B CKD.

      Abstract

      Background

      We hypothesized that a reversal of the physiological stiffness gradient, previously reported in end-stage renal disease, begins in the early stages of chronic kidney disease (CKD) and that chronic inflammation produces a different arterial phenotype in patients with ulcerative colitis (UC).

      Objectives

      To assess the extent of arterial stiffening in the central (carotid-femoral pulse wave velocity, cf.-PWV) and peripheral arteries (carotid-radial pulse wave velocity, cr-PWV) and to explore the determinants of the stiffness gradient in UC and in CKD.

      Methods

      We enrolled 45 patients with UC, 45 patients with stage 3–4 CKD and 45 matched controls.

      Results

      Despite the comparable cf.-PWV, the cr-PWV was higher in patients with UC than in those with CKD (median: 8.7 vs. 7.5 m/s; p < 0.001) and, consequently, the PWV ratio was lower (median: 0.97 vs. 1.12; p < 0.001). In patients with CKD a stiffness mismatch was reported starting from stage 3B. The PWV ratio was associated with age and C-reactive protein (beta: 0.08 z-score, 95%CI 0.02–0.14; p = 0.01) or active disease (beta: 0.43 z-score, 95%CI 0.003–0.857; p = 0.048) in patients with UC and with age and glomerular filtration rate (beta: −0.56 z-score, 95%CI −1.05 to −0.07; p = 0.02) in patients with CKD.

      Conclusions

      The arterial phenotype differed between UC and CKD. The reversal of the arterial stiffness gradient is evident in CKD patients starting from stage 3B but not in patients with UC and comparable cf.-PWV. In patients with UC, the stiffness of both elastic and muscular arteries is increased as a consequence of inflammation.

      Graphical abstract

      Abbreviations:

      [email protected] (heart-rate-adjusted central augmentation index), Anti-TNF (anti-tumor necrosis factor), cf-PWV (carotid-femoral pulse wave velocity), CKD (chronic kidney disease), cr-PWV (carotid-radial pulse wave velocity), DBP (diastolic blood pressure), eGFR (estimated GFR), IBD (inflammatory bowel disease), MBP (mean blood pressure), PP (pulse pressure), SBP (systolic blood pressure), UC (ulcerative colitis)

      Keywords

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