Target renal damage: the microvascular associations of increased aortic stiffness in patients with COPD

Respiratory Research

Charlotte E Bolton¹  John R Cockcroft²  Rebecca Simms¹  Andrew Prayle³  Samia Hussain¹  Michelle John¹ 

[1] Nottingham Respiratory Research Unit, University of Nottingham, Clinical Sciences Building, City Hospital Campus, Hucknall road, Nottingham NG5 1PB, UK;Wales Heart Research Institute, Cardiff University, Heath Park, Cardiff CF14 4XN, UK;Department of Child Health, University of Nottingham, QMC Campus, Nottingham NG7 2UH, UK

关键词: Microvascular;    Renal;    Kidney;    Haemodynamics;    Biomarkers;    Arterial stiffness;   

Others  :  794950
DOI  :  10.1186/1465-9921-14-31

 received in 2013-01-08, accepted in 2013-03-01,  发布年份 2013

【 摘 要 】

Background

Although renal impairment has been described in COPD, there is opportunity to evaluate further to determine nature and consider optimal management. Increased aortic stiffness, as seen in COPD, leads to reduced buffering of pulsatile flow. We hypothesised that urinary albumin creatinine ratio (UACR) would reflect glomerular damage related to aortic stiffness.

Methods

Patients with COPD and controls underwent spirometry, blood pressure, arterial stiffness - aortic pulse wave velocity (PWV) and provided a spot urine sample for UACR, with other renal biomarkers measured.

Results

The UACR was increased in patients (n = 52): 0.80 mg/mmol compared to controls (n = 34): 0.46 mg/mmol, p < 0.05. Aortic PWV was related to log₁₀ UACR in all subjects (r = 0.426, p < 0.001) and COPD patients alone. Aortic PWV was a significant variable for UACR with oxygen saturations, after accounting for potential confounders. Eight subjects (7 patients) reached a defined clinical microalbuminuria threshold, with aortic PWV greater in these patients compared to those patients without, although albuminuria is a continuum. Proximal tubular damage biomarkers, unlike the glomerular marker, were not different between patients and controls.

Conclusions

There is glomerular damage in patients with COPD evidenced by increased UACR, related to increased aortic stiffness. Besides the macrovascular prognostic implications of increased aortic stiffness, the microvascular state in COPD management should be considered.

【 授权许可】

   
2013 John et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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