Abstract
The aim of this study was to investigate the associations between carotid wall shear stress (WSS) and renal function impairment (RFI) and albuminuria in aging adults. A total of 1,447 subjects aged 60 years and older with normal estimated glomerular filtration rate (eGFR ≥ 60 mL·min−1·1.72 m−2) and albumin/creatinine ratio (ACR < 30 mg·g−1) were enrolled between April 2007 and October 2009 in the Shandong area, China. Carotid WSS was assessed at baseline, and eGFR, which is based on serum creatinine and cystatin C, and ACR were assessed at baseline and at the annual follow-up visits. After an average of 62.9 months of follow-up, the reduction in eGFR and the increase in ACR were significantly higher in the Q1+2+3 group than the Q4 group, as classified by either the interquartile of the mean WSS or the interquartile of the peak WSS after adjustment for multi-variabilities, including the average blood pressures at every annual visit and baseline eGFR and ACR. For groups classified by mean WSS, the hazard ratios (95% confidence intervals) were 3.45 (1.36–8.75, p = 0.008) in the incident RFI and 3.24 3.22 (1.37–7.57, p = 0.009) in the incident albuminuria for the Q1+2+3 group compared with the Q4 group. Similar results were observed among groups classified by peak WSS. The Q1+2+3 group was associated with endothelial dysfunction and inflammation with respect to the Q4 group as classified by mean or peak WSS. The results indicate that carotid WSS plays an important role in RFI and albuminuria progression in aging adults. Lower WSS was associated with a higher risk of RFI and albuminuria compared with higher WSS.
Highlights
Chronic renal function impairment (RFI) is thought to share risk factors for atherosclerosis and endothelial dysfunction[4,8,9]
Among the 1,447 participants, 1,434 completed at least one follow-up visit during an average of 62.9 months of follow-up. eGFR was significantly lower and ACR was higher in the Q1+2+3 group than the Q4 group, which were classified by MWSS and PWSS separately
In the Q1+2+3 and Q4 groups, which were classified by MWSS and PWSS separately, serum nitric oxide (NO) levels decreased and serum ET-1, intercellular adhesion molecule (ICAM)-1, vascular cell adhesion molecule (VCAM)-1, and hypersensitive C-reactive protein (hsCRP) levels over the follow-up period significantly increased in the Q1+2+3 group compared with the Q4 group
Summary
Chronic RFI is thought to share risk factors for atherosclerosis and endothelial dysfunction[4,8,9] Among these risk factors, an important hemodynamic force called wall shear stress (WSS) plays a crucial role as a fluid mechanical mediator in endothelial cellular activities and vascular remodeling[10]. The CCA is a well-established “observation window” for monitoring and measurement of systemic hemodynamic conditions in humans, thereby allowing precise regulation of blood flow[17], and the carotid WSS may represent the overall hemodynamic condition of renal vessels[9,18,19]. This study was a cross-sectional study and could not clearly illuminate the association between carotid WSS and renal function. The main goal of this study was to conduct a community-based investigation of this association in an aging adult population
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