Central haemodynamics linked to renal microvascular damage
18 Sep 2021
29 sources of inaccuracy have been identified in the measurement of adults’ resting blood pressure in clinical settings.Abnormalities in central haemodynamic parameters may be linked to renal microvascular damage among young and middle-aged nondiabetic kidney disease patients despite preserved renal function, a recent study has found.
Researchers enrolled 44 nondiabetic patients aged 18–50 years (52.3 percent men) with preserved renal function. Histological analyses were performed after renal biopsy, including assessments for arteriole wall thickening and arteriole hyalinosis, conducted semiquantitatively through staining. Noninvasive central haemodynamic measurements were collected: central and brachial blood pressure (BP) and brachial-ankle pulse wave velocity (baPWV).
Overall, 39.2±22.7 percent and 37.4±22.7 percent of participants showed arteriolar wall thickening and arteriolar hyalinosis, respectively. Global glomerulosclerosis was observed in 9.1 percent. Majority of the instances of fibrous intimal thickening of the small arteries remained grade 0 to grade 2, as did other histological outcomes, such as the interstitial fibrosis/tubular atrophy and interstitial cell infiltration grades.
Multivariate analysis found that the remodeling grade index, used to quantify changes in the arteriolar wall, was significantly affected by central systolic BP (β, 0.98±0.01; p=0.005) and pulse pressure (β, 0.48±0.01; p=0.012), but not by baPWV (p=0.10).
On the other hand, baPWV was the only parameter significantly correlated with the hyalinosis index, used to quantify the degree of arteriolar hyalinosis (β, 0.92±0.001; p=0.002). Central systolic BP (p=0.38) and pulse pressure (p=0.32) showed no such interaction.
“These results suggest that the improvement in central haemodynamics caused by lifestyle interventions and pharmacotherapy might contribute to the suppression of structural alterations in the small renal arteries. Further studies are needed to determine whether maintaining appropriate levels of vascular function parameters will reduce histological damage in the kidney,” the researchers said.