THE RELATIONSHIP BETWEEN ARTERIAL STIFFNESS, SUBCLINICAL HEART FAILURE, CARDIAC FIBROSIS AND RENAL FUNCTION IN CHRONIC KIDNEY DISEASE, IGA NEPHROPATHY

Abstract

Objective: IgA nephropathy (IgAN) is the most common primary glomerular disease worldwide. Arterial stiffness may predict cardiovascular (CV) mortality and morbidity in chronic kidney disease (CKD). Heart failure is very common in advanced CKD stages. Onset of myocardial fibrosis may be a pathophysiological alteration in CKD patients with heart failure. Design and method: In our cross-sectional study, we examined 90 patients who cared for IgAN in our clinic. Arterial stiffness was determined by measuring carotis-femoral pulse wave velocity (cfPWV) using the ShygmoCor device. N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and carboxy-terminal telopeptide of collagen type I (CITP) were measured using ELISA kits. Renal function was detected by the estimated glomerular filtration rate (eGFR-CKD-EPI). Furthermore, a routine echocardiography examination was performed. Results: Of the 90 patients included in the study, 50 were male, with a mean age of 54.9 ± 14.4 years. Patients were divided into two groups based on eGFR (CKD 1-2 and CKD 3-5). There were significantly higher NT-proBNP (p = 0.035), cfPWV (p = 0.004), and central aortic systolic pressure (p = 0.037), but not CITP, in the CKD 3-5 group. The number of patients with combined biomarker positivity (NT-proBNP and CITP) was also significantly higher in the CKD3-5 group (p = 0.035) compared to the CKD 1-2 group. The central aortic systolic pressure was significantly higher in the diastolic dysfunction group (p = 0.034), but the systolic blood pressure was not. eGFR and hemoglobin level showed a strong negative correlation, while left ventricular mass index (LVMI), aortic pulse pressure, central aortic systolic pressure, and cfPWV showed a positive correlation with NT-proBNP. cfPWV, aortic pulse pressure, and LVMI showed a strong positive correlation with CITP by Spearman's correlation. Only eGFR was an independent predictor of NT-proBNP by linear regression analysis. Conclusions: A possible mechanism for the development of heart failure in CKD patients may be an elevation of central aortic systolic pressure. NT-proBNP and CITP biomarkers may help to identify IgAN patients at high risk for subclinical heart failure and further atherosclerotic disease.