Endothelial vasomotor dysfunction in the brachial artery predicts the short-term development of early stage renal dysfunction in patients with coronary artery disease

Abstract

Background This study examined whether endothelial vasomotor dysfunction in the brachial artery predicted early renal dysfunction in patients with coronary artery disease (CAD). Endothelial function in the renal vasculature plays an important role in the regulation of renal hemodynamics. As endothelial dysfunction is a systemic disorder, there may be a relationship between endothelial function in the brachial artery and renal vasculature. Methods Flow-mediated endothelium-dependent dilation (FMD) in brachial artery and renal functional parameters were measured in 757 patients with CAD without macroalbuminuria. Results In a cross-sectional data, an impaired FMD was associated with higher serum creatinine levels and urinary albumin excretion (UAE), lower creatinine clearance rate and estimated glomerular filtration rate (eGFR) at baseline in multiple linear regression analysis. In a follow-up study including a subgroup of 448 patients with normal renal function (serum creatinine level < 1.0 mg/dL, UAE < 25 mg/day and eGFR ≥ 60 mL/min/1.73 m 2 at baseline), 96 patients had an endpoint of early stage renal dysfunction (serum creatinine levels ≥ 1.2 mg/dL, UAE ≥ 30 mg/day and/or eGFR < 60 mL/min/1.73 m 2) during 12 month follow-up. Multivariate logistic regression analysis showed that impaired FMD was significantly associated with progression to the early stage renal dysfunction after adjustment with age, diabetes mellitus, hypertension and C-reactive protein levels. Conclusions Endothelial vasomotor dysfunction in the brachial artery is independently associated with progression from normal renal function to early stage renal dysfunction in patients with CAD. Measurement of FMD may therefore be useful for assessing risk of future renal dysfunction.