The Relationship between Advanced Oxidation Protein Products, Vascular Calcifications and Arterial Stiffness in Predialysis Chronic Kidney Disease Patients.

Andreea Taisia Tiron,Ionel Alexandru Checherita,Dana Manda,Ion-Vlad Vinereanu,Andrei Niculae,Andra Caragheorgheopol,Ileana Peride

doi:10.3390/medicina57050452

Abstract

Background and Objectives: Cardiovascular morbidity and mortality are increased in patients with chronic kidney disease (CKD). It is likely that the accumulation of uremic toxins resulting in increased oxidative stress (OS) is a major contributing factor, but no clear link has been identified. The purpose of this research is to establish if advanced oxidation protein product (AOPP) levels in the serum of predialysis patients are a contributing factor to vascular calcification and increased arterial stiffness. Materials and Methods: After obtaining the informed consent, 46 predialysis patients (CKD stages G3–G5) were included in the study. In order to identify vascular calcifications, hand and pelvic radiographs were performed. Valvular calcifications were identified using cardiac ultrasound. AOPP were measured using a commercially available ELISA kit. The relationships between serum AOPP values and biochemical parameters relevant in the evaluation of CKD patients were analyzed. In addition to identifying the differences in AOPP levels between patients with/without vascular or valvular calcifications, the research focused on describing the relationship between OS and arterial stiffness assessed by oscillometric pulse-wave velocity (PWV) measurement. Results: No significant relationship between serum AOPP and vascular or valvular calcifications was highlighted, but significant correlations of AOPP with C-reactive protein (p = 0.025), HDL-cholesterol levels (p = 0.04), HbA1c (p = 0.05) and PWV values (p = 0.02) were identified. Conclusions: The usefulness of (OS) measurement in clinical practice remains debatable; however, the relationship between AOPP and arterial stiffness could be valuable in improving cardiovascular risk assessment of patients with CKD.

Highlights

Introduction iationsOxidative stress (OS) is a key pathological feature of chronic kidney disease (CKD)that results, partly, from prolonged exposure to uremic toxins and contributes to patient morbidity and mortality
74 patients diagnosed with chronic kidney disease (CKD) stages G3–G5 were invited to participate in this study, but after applying the inclusion and exclusion criteria, a total of 46 patients were enrolled: 22 females and 24 males, with a mean age of 65.07 ± 13.89 years and a median glomerular filtration rate of 10 mL/min/1.73 m2
Systemic vascular calcifications are an important determinant of poor cardiovascular outcomes in patients with CKD; the relationship with uremic toxins and oxidative stress (OS) has yet to be highlighted in clinical practice

Summary

Introduction

Introduction iationsOxidative stress (OS) is a key pathological feature of chronic kidney disease (CKD)that results, partly, from prolonged exposure to uremic toxins and contributes to patient morbidity and mortality. Oxidative stress (OS) is a key pathological feature of chronic kidney disease (CKD). The quantification of reactive oxygen species (ROS) could only be performed in vitro studies, because ROS have very short half-lives and usually react with other molecules near the site where they are produced, making it difficult to isolate and adequately analyze them [1]. Proteins and nucleic acids, producing more stable compounds that can be assessed as biological markers of OS [1]. The available markers indirectly evaluate the levels of ROS and are not able to identify the source of free radicals [2]. CKD (i.e., diabetes mellitus, hypertension, atherosclerosis) are themselves major disruptors.

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