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Cardio-ankle vascular index is linked to deranged metabolic status, especially high HbA1c and monocyte-chemoattractant-1 protein, in predialysis chronic kidney disease

  • Nephrology - Original Paper
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Abstract

Introduction and purpose

Arterial stiffness is an independent predictor of cardiovascular disease in chronic kidney disease (CKD). Cardio-ankle vascular index (CAVI) is a newly developed method used to assess arterial stiffness, independent of changes in blood pressure. CAVI reflects stiffness and atherosclerosis at the thoracic, abdominal, common iliac, femoral, and tibial artery levels. In predialysis stage 3–5 diabetic and nondiabetic CKD patients, CAVI levels and its relation to atherosclerosis-associated risk factors including monocyte-chemoattractant protein-1 (MCP-1), sclerostin, fibroblast growth factor-23 (FGF-23), Klotho, and 25-OH vitamin D were determined.

Materials and methods

The study was performed on three age-matched and gender-matched groups. Group 1 included 46 stage 3–5 nondiabetic CKD patients, group 2 included 44 stage 3–5 diabetic CKD patients, and group 3 included 44 non-uremic controls. All subjects underwent CAVI measurement. Serum glycated hemoglobin (HbA1c), total calcium, phosphorus, parathormone, FGF-23, Klotho, MCP-1, sclerostin, and 25-OH vitamin D were determined using standard methods.

Results

CAVI level was 8.22 ± 0.18 m/s in diabetic CKD patients and significantly higher than in nondiabetic CKD (7.61 ± 0.18 m/s) and control (7.59 ± 0.17 m/s) patients. FGF-23 level was higher in the CKD groups than controls but not statistically significant. MCP-1 level was significantly higher in diabetic CKD patients. Klotho and sclerostin levels were significantly lower in diabetic CKD patients. In the whole cohort, CAVI showed positive correlations with age (r = 0.447, p < 0.0001), smoking (r = 0.331, p = 0.035), mean arterial blood pressure (MABP; r = 0.327, p < 0.0001), fasting blood glucose (r = 0.185, p = 0.033), and HbA1c (r = 0.258, p = 0.003). Stepwise regression analysis revealed that age (p = 0.0001, B = 0.461), MABP (p < 0.0001, B = 0.365), HbA1c (p = 0.003, B = 0.251), and MCP-1 (p = 0.013, B = 0.214) independently predicted CAVI levels.

Conclusion

Our results indicate higher CAVI levels, therefore, resulting in increased arterial stiffness in the setting of diabetic CKD. Apart from age and MABP, deranged metabolic status, especially increased HbA1c and MCP-1 levels, is also independently associated with increasing CAVI levels in CKD patients. These results emphasize the importance of metabolic control in the development of arterial stiffness in CKD patients, which is an early predictor of developing cardiovascular complications.

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Funding

The results presented in this paper have not been published previously in whole or part, except in abstract format. This study was funded by Pamukkale University Scientific Research Projects with the project number 2015TPF025 (Turkey/Denizli).

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Author notes

  1. Mehmet Mert and Belda Dursun are contributed equally to this work.

Authors and Affiliations

  1. Internal Medicine, Tavas State Hospital, Denizli, Turkey

    Mehmet Mert

  2. Nephrology, Pamukkale University Medical School, Denizli, Turkey

    Belda Dursun

  3. Radiology, Pamukkale University Medical School, Denizli, Turkey

    Ahmet Baki Yağcı

  4. Biochemistry, Pamukkale University Medical School, Denizli, Turkey

    Ayşen Çetin Kardeşler & Süleyman Demir

  5. Biostatistics, Pamukkale University Medical School, Denizli, Turkey

    Hande Şenol

Authors
  1. Mehmet Mert
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Contributions

The study was designed by Belda DURSUN and Mehmet MERT. After the approval of other authors, the project was started. To carry out biochemical analysis from blood samples taken from patients, help was obtained from Ayşen ÇETİN KARDEŞLER and Süleyman DEMİR. CAVI measurements of the patients were performed by Ahmet Baki YAĞCI and Mehmet MERT. Biostatistical analysis of the data was done by Hande ŞENOL.

Corresponding author

Correspondence to Mehmet Mert.

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Conflict of interest

The author Mehmet MERT declares that he has no conflict of interest. The author Belda DURSUN declares that she has no conflict of interest. The author Ahmet Baki YAĞCI declares that he has no conflict of interest. The author Ayşen ÇETİN KARDEŞLER declares that she has no conflict of interest. The author Süleyman DEMİR declares that he has no conflict of interest. The author Hande ŞENOL declares that she has no conflict of interest. We would like to thank all the patients who participated in the study and Enago (www.enago.com) for the English language review.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was started following the approval of Pamukkale University Non-invasive Clinical Research Ethics Committee meeting dated 07.04.2015 and numbered 2015/04 (Turkey/Denizli). Informed consent was obtained from all individual participants included in the study.

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Mert, M., Dursun, B., Yağcı, A.B. et al. Cardio-ankle vascular index is linked to deranged metabolic status, especially high HbA1c and monocyte-chemoattractant-1 protein, in predialysis chronic kidney disease. Int Urol Nephrol 52, 137–145 (2020). https://doi.org/10.1007/s11255-019-02336-6

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  • DOI: https://doi.org/10.1007/s11255-019-02336-6

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