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Coronary microvascular dysfunction is associated with degree of anaemia in end‐stage renal disease

BACKGROUND: Coronary microvascular dysfunction (CMD) is common in end-stage renal disease (ESRD) and is an adverse prognostic marker. Coronary flow velocity reserve (CFVR) is a measure of coronary microvascular function and can be assessed using Doppler echocardiography. Reduced CFVR in ESRD has bee...

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Autores principales: Radhakrishnan, Ashwin, Pickup, Luke C., Price, Anna M., Law, Jonathan P., McGee, Kirsty C., Fabritz, Larissa, Senior, Roxy, Steeds, Richard P., Ferro, Charles J., Townend, Jonathan N.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8074270/
https://www.ncbi.nlm.nih.gov/pubmed/33902440
http://dx.doi.org/10.1186/s12872-021-02025-2
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author Radhakrishnan, Ashwin
Pickup, Luke C.
Price, Anna M.
Law, Jonathan P.
McGee, Kirsty C.
Fabritz, Larissa
Senior, Roxy
Steeds, Richard P.
Ferro, Charles J.
Townend, Jonathan N.
author_facet Radhakrishnan, Ashwin
Pickup, Luke C.
Price, Anna M.
Law, Jonathan P.
McGee, Kirsty C.
Fabritz, Larissa
Senior, Roxy
Steeds, Richard P.
Ferro, Charles J.
Townend, Jonathan N.
author_sort Radhakrishnan, Ashwin
collection PubMed
description BACKGROUND: Coronary microvascular dysfunction (CMD) is common in end-stage renal disease (ESRD) and is an adverse prognostic marker. Coronary flow velocity reserve (CFVR) is a measure of coronary microvascular function and can be assessed using Doppler echocardiography. Reduced CFVR in ESRD has been attributed to factors such as diabetes, hypertension and left ventricular hypertrophy. The contributory role of other mediators important in the development of cardiovascular disease in ESRD has not been studied. The aim of this study was to examine the prevalence of CMD in a cohort of kidney transplant candidates and to look for associations of CMD with markers of anaemia, bone mineral metabolism and chronic inflammation. METHODS: Twenty-two kidney transplant candidates with ESRD were studied with myocardial contrast echocardiography, Doppler CFVR assessment and serum multiplex immunoassay analysis. Individuals with diabetes, uncontrolled hypertension or ischaemic heart disease were excluded. RESULTS: 7/22 subjects had CMD (defined as CFVR < 2). Demographic, laboratory and echocardiographic parameters and serum biomarkers were similar between subjects with and without CMD. Subjects with CMD had significantly lower haemoglobin than subjects without CMD (102 g/L ± 12 vs. 117 g/L ± 11, p = 0.008). There was a positive correlation between haemoglobin and CFVR (r = 0.7, p = 0.001). Similar results were seen for haematocrit. In regression analyses, haemoglobin was an independent predictor of CFVR (β = 0.041 95% confidence interval 0.012–0.071, p = 0.009) and of CFVR < 2 (odds ratio 0.85 95% confidence interval 0.74–0.98, p = 0.022). CONCLUSIONS: Among kidney transplant candidates with ESRD, there is a high prevalence of CMD, despite the absence of traditional risk factors. Anaemia may be a potential driver of microvascular dysfunction in this population and requires further investigation.
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spelling pubmed-80742702021-04-26 Coronary microvascular dysfunction is associated with degree of anaemia in end‐stage renal disease Radhakrishnan, Ashwin Pickup, Luke C. Price, Anna M. Law, Jonathan P. McGee, Kirsty C. Fabritz, Larissa Senior, Roxy Steeds, Richard P. Ferro, Charles J. Townend, Jonathan N. BMC Cardiovasc Disord Research BACKGROUND: Coronary microvascular dysfunction (CMD) is common in end-stage renal disease (ESRD) and is an adverse prognostic marker. Coronary flow velocity reserve (CFVR) is a measure of coronary microvascular function and can be assessed using Doppler echocardiography. Reduced CFVR in ESRD has been attributed to factors such as diabetes, hypertension and left ventricular hypertrophy. The contributory role of other mediators important in the development of cardiovascular disease in ESRD has not been studied. The aim of this study was to examine the prevalence of CMD in a cohort of kidney transplant candidates and to look for associations of CMD with markers of anaemia, bone mineral metabolism and chronic inflammation. METHODS: Twenty-two kidney transplant candidates with ESRD were studied with myocardial contrast echocardiography, Doppler CFVR assessment and serum multiplex immunoassay analysis. Individuals with diabetes, uncontrolled hypertension or ischaemic heart disease were excluded. RESULTS: 7/22 subjects had CMD (defined as CFVR < 2). Demographic, laboratory and echocardiographic parameters and serum biomarkers were similar between subjects with and without CMD. Subjects with CMD had significantly lower haemoglobin than subjects without CMD (102 g/L ± 12 vs. 117 g/L ± 11, p = 0.008). There was a positive correlation between haemoglobin and CFVR (r = 0.7, p = 0.001). Similar results were seen for haematocrit. In regression analyses, haemoglobin was an independent predictor of CFVR (β = 0.041 95% confidence interval 0.012–0.071, p = 0.009) and of CFVR < 2 (odds ratio 0.85 95% confidence interval 0.74–0.98, p = 0.022). CONCLUSIONS: Among kidney transplant candidates with ESRD, there is a high prevalence of CMD, despite the absence of traditional risk factors. Anaemia may be a potential driver of microvascular dysfunction in this population and requires further investigation. BioMed Central 2021-04-26 /pmc/articles/PMC8074270/ /pubmed/33902440 http://dx.doi.org/10.1186/s12872-021-02025-2 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Radhakrishnan, Ashwin
Pickup, Luke C.
Price, Anna M.
Law, Jonathan P.
McGee, Kirsty C.
Fabritz, Larissa
Senior, Roxy
Steeds, Richard P.
Ferro, Charles J.
Townend, Jonathan N.
Coronary microvascular dysfunction is associated with degree of anaemia in end‐stage renal disease
title Coronary microvascular dysfunction is associated with degree of anaemia in end‐stage renal disease
title_full Coronary microvascular dysfunction is associated with degree of anaemia in end‐stage renal disease
title_fullStr Coronary microvascular dysfunction is associated with degree of anaemia in end‐stage renal disease
title_full_unstemmed Coronary microvascular dysfunction is associated with degree of anaemia in end‐stage renal disease
title_short Coronary microvascular dysfunction is associated with degree of anaemia in end‐stage renal disease
title_sort coronary microvascular dysfunction is associated with degree of anaemia in end‐stage renal disease
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8074270/
https://www.ncbi.nlm.nih.gov/pubmed/33902440
http://dx.doi.org/10.1186/s12872-021-02025-2
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