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Modifiable risk factors for increased arterial stiffness in outpatient nephrology.

Elewa U, Fernandez-Fernandez B, Alegre R, Sanchez-Niño MD, Mahillo-Fernández I, Perez-Gomez MV, El-Fishawy H, Belal D, Ortiz A - PLoS ONE (2015)

Bottom Line: A new parameter, Delta above upper limit of normal PWV (Delta PWV) was defined to decrease the weight of age on PWV values.In conclusion, arterial stiffness was frequent in nephrology outpatients.Systolic blood pressure, smoking, serum uric acid, calcium-containing medications, potassium metabolism and non-use of beta blockers are modifiable factors associated with increased arterial stiffness in Nephrology outpatients.

View Article: PubMed Central - PubMed

Affiliation: IIS-Fundación Jiménez Díaz, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; Fundación Renal Iñigo Alvarez de Toledo-IRSIN, Madrid, Spain; REDINREN, Madrid, Spain; Kasr El-Aini University Hospitals, Cairo University, Cairo, Egypt.

ABSTRACT
Arterial stiffness, as measured by pulse wave velocity (PWV), is an independent predictor of cardiovascular events and mortality. Arterial stiffness increases with age. However, modifiable risk factors such as smoking, BP and salt intake also impact on PWV. The finding of modifiable risk factors may lead to the identification of treatable factors, and, thus, is of interest to practicing nephrologist. We have now studied the prevalence and correlates of arterial stiffness, assessed by PWV, in 191 patients from nephrology outpatient clinics in order to identify modifiable risk factors for arterial stiffness that may in the future guide therapeutic decision-making. PWV was above normal levels for age in 85/191 (44.5%) patients. Multivariate analysis showed that advanced age, systolic BP, diabetes mellitus, serum uric acid and calcium polystyrene sulfonate therapy or calcium-containing medication were independent predictors of PWV. A new parameter, Delta above upper limit of normal PWV (Delta PWV) was defined to decrease the weight of age on PWV values. Delta PWV was calculated as (measured PWV) - (upper limit of the age-adjusted PWV values for the general population). Mean±SD Delta PWV was 0.76±1.60 m/sec. In multivariate analysis, systolic blood pressure, active smoking and calcium polystyrene sulfonate therapy remained independent predictors of higher delta PWV, while age, urinary potassium and beta blocker therapy were independent predictors of lower delta PWV. In conclusion, arterial stiffness was frequent in nephrology outpatients. Systolic blood pressure, smoking, serum uric acid, calcium-containing medications, potassium metabolism and non-use of beta blockers are modifiable factors associated with increased arterial stiffness in Nephrology outpatients.

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Correlations between quantitative variables and PWV that are significant in the univariate analysis and remained significant in the multivariate analysis.
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pone.0123903.g001: Correlations between quantitative variables and PWV that are significant in the univariate analysis and remained significant in the multivariate analysis.

Mentions: PWV was significantly higher in patients with DM, hypertension, history of CVD, male gender and treated with calcium-containing phosphate binders, calcium polystyrene sulfonate or any calcium-containing medication, iron supplements, statins, ezetimibe, angiotensin receptor blockers, diuretics, alpha blockers, proton pump inhibitors or anti-platelet agents (S3 Table). In addition, in univariate analysis PWV (m/sec) positively correlated with age, systolic BP, pulse pressure, ejection fraction, UACR, serum uric acid, glucose and HbA1c and negatively correlated with eGFR, total serum cholesterol, LDL cholesterol and, 1,25(OH)2D (Table 1). Fig 1 shows univariate correlations between PWV and variables that remained significant in the multivariate analysis.


Modifiable risk factors for increased arterial stiffness in outpatient nephrology.

Elewa U, Fernandez-Fernandez B, Alegre R, Sanchez-Niño MD, Mahillo-Fernández I, Perez-Gomez MV, El-Fishawy H, Belal D, Ortiz A - PLoS ONE (2015)

Correlations between quantitative variables and PWV that are significant in the univariate analysis and remained significant in the multivariate analysis.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4400164&req=5

pone.0123903.g001: Correlations between quantitative variables and PWV that are significant in the univariate analysis and remained significant in the multivariate analysis.
Mentions: PWV was significantly higher in patients with DM, hypertension, history of CVD, male gender and treated with calcium-containing phosphate binders, calcium polystyrene sulfonate or any calcium-containing medication, iron supplements, statins, ezetimibe, angiotensin receptor blockers, diuretics, alpha blockers, proton pump inhibitors or anti-platelet agents (S3 Table). In addition, in univariate analysis PWV (m/sec) positively correlated with age, systolic BP, pulse pressure, ejection fraction, UACR, serum uric acid, glucose and HbA1c and negatively correlated with eGFR, total serum cholesterol, LDL cholesterol and, 1,25(OH)2D (Table 1). Fig 1 shows univariate correlations between PWV and variables that remained significant in the multivariate analysis.

Bottom Line: A new parameter, Delta above upper limit of normal PWV (Delta PWV) was defined to decrease the weight of age on PWV values.In conclusion, arterial stiffness was frequent in nephrology outpatients.Systolic blood pressure, smoking, serum uric acid, calcium-containing medications, potassium metabolism and non-use of beta blockers are modifiable factors associated with increased arterial stiffness in Nephrology outpatients.

View Article: PubMed Central - PubMed

Affiliation: IIS-Fundación Jiménez Díaz, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; Fundación Renal Iñigo Alvarez de Toledo-IRSIN, Madrid, Spain; REDINREN, Madrid, Spain; Kasr El-Aini University Hospitals, Cairo University, Cairo, Egypt.

ABSTRACT
Arterial stiffness, as measured by pulse wave velocity (PWV), is an independent predictor of cardiovascular events and mortality. Arterial stiffness increases with age. However, modifiable risk factors such as smoking, BP and salt intake also impact on PWV. The finding of modifiable risk factors may lead to the identification of treatable factors, and, thus, is of interest to practicing nephrologist. We have now studied the prevalence and correlates of arterial stiffness, assessed by PWV, in 191 patients from nephrology outpatient clinics in order to identify modifiable risk factors for arterial stiffness that may in the future guide therapeutic decision-making. PWV was above normal levels for age in 85/191 (44.5%) patients. Multivariate analysis showed that advanced age, systolic BP, diabetes mellitus, serum uric acid and calcium polystyrene sulfonate therapy or calcium-containing medication were independent predictors of PWV. A new parameter, Delta above upper limit of normal PWV (Delta PWV) was defined to decrease the weight of age on PWV values. Delta PWV was calculated as (measured PWV) - (upper limit of the age-adjusted PWV values for the general population). Mean±SD Delta PWV was 0.76±1.60 m/sec. In multivariate analysis, systolic blood pressure, active smoking and calcium polystyrene sulfonate therapy remained independent predictors of higher delta PWV, while age, urinary potassium and beta blocker therapy were independent predictors of lower delta PWV. In conclusion, arterial stiffness was frequent in nephrology outpatients. Systolic blood pressure, smoking, serum uric acid, calcium-containing medications, potassium metabolism and non-use of beta blockers are modifiable factors associated with increased arterial stiffness in Nephrology outpatients.

Show MeSH
Related in: MedlinePlus