Coronary flow velocity reserve and inflammatory markers in living kidney donors. (1st December 2020)

• Record Type: Journal Article
• Authors: Radhakrishnan, Ashwin; Price, Anna M.; Pickup, Luke C.; Law, Jonathan P.; McGee, Kirsty C.; Fabritz, Larissa; Senior, Roxy; Steeds, Richard P.; Ferro, Charles J.; Townend, Jonathan N.
• Is Part Of: International journal of cardiology. Volume 320(2020)
• Page Start: 141
• Page End: 147
• Publication Date: 2020-12-01
• Subjects: Living kidney donors -- Coronary microvascular dysfunction -- Coronary flow velocity reserve -- Inflammation; BP Blood pressure -- CAD Coronary artery disease -- CFR Coronary flow reserve -- CFVR Coronary flow velocity reserve -- CFV Coronary flow velocity -- CKD Chronic kidney disease -- CMD Coronary microvascular dysfunction -- CRIB-Donor Chronic Renal Impairment in Birmingham - Donor study -- CRIB-FLOW Chronic Renal Impairment in Birmingham Coronary FLOW Reserve study -- CRP C reactive peptide -- ECG Electrocardiogram -- eGFR Estimated glomerular filtration rate -- IL-1ra Interleukin-1 receptor antagonist -- IL-6 Interleukin-6 -- IL-8 Interleukin-8 -- hsCRP High sensitivity C reactive peptide -- LKD Living kidney donors -- LVH Left ventricular hypertrophy -- MCE Myocardial contrast echocardiogram -- MI Mechanical index -- SD Standard deviation -- SNS Sympathetic nervous system -- TNFα Tumour necrosis factor α -- TTE Transthoracic echocardiogram -- QEHB Queen Elizabeth Hospital Birmingham -- UK United Kingdom; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2020.08.013
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Coronary microvascular dysfunction is prevalent in chronic kidney disease (CKD), and may contribute to the development of myocardial dysfunction in CKD. Coronary flow velocity reserve (CFVR) is a marker of coronary microvascular function and falls with increasing CKD stage. Living kidney donors have renal function consistent with early stage CKD and concern has been raised about their cardiovascular risk. No studies to date have investigated the presence of coronary microvascular dysfunction in living kidney donors. Methods: 25 healthy controls and 23 living kidney donors were recruited and underwent assessment with transthoracic echocardiography, Doppler CFVR, myocardial contrast echocardiography and serum multiplex immunoassay panels. Results: Doppler CFVR was significantly reduced in living kidney donors compared to controls (mean CFVR 3.4 ± 0.7 vs 3.8 ± 0.6, mean difference 0.4 95% confidence interval 0.03–0.8, p =.036). Quantitative myocardial contrast echocardiography showed a trend towards reduced coronary flow reserve in living kidney donors. Compared to controls, living kidney donors had higher serum high sensitivity C reactive peptide (hsCRP) and lower levels of uromodulin. Conclusions: This is the first study of CFVR in living kidney donors. We have shown that the modest drop in estimated glomerular filtration rate in living kidney donors is associated with lower values of Doppler CFVR compared to controls, suggesting that isolated reductions in renal function may lead to altered microvascular function. The increase in hsCRP and reduction in uromodulin suggests that chronic subclinical inflammation may contribute to altered microvascular function in this population. Highlights: Coronary flow velocity reserve is reduced in living kidney donors compared to controls. Markers of inflammation are elevated in living kidney donors. Inflammation may cause coronary microvascular dysfunction in living kidney donors. Living kidney donors need aggressive cardiovascular risk factor management.