Abstract

INSERRA, Felipe; LAVENIA, Gustavo; FORCADA, Pedro  and  BELLO, Carlos Castellaro. Systemic Vasculature In Chronic Kidney Disease. Second Part. Rev. nefrol. dial. traspl. [online]. 2020, vol.40, n.1, pp.62-75. ISSN 2346-8548.

There exist significant structural changes in the artery wall in almost all clinical stages of chronic kidney disease. They constitute a prognostic marker and, at the same time, a progression factor and an event factor, both cardiovascular and renal. For that reason, it is essential to have an estimation of vascular damage and, even better, an accurate diagnosis.

Vascular evaluation during clinical consultation by means of determining pulse pressure and ankle-brachial pressure index are a helpful initial orientation of these patient´s artery damage. Today we can assess, in an accessible way, the structural lesions of the arteries by means of quantification and characterization, through vascular ultrasound, of carotid and femoral atherosclerotic plaques and through the pulse wave velocity. The vast majority of renal patients show increased pulse wave velocity, compared to healthy populations, as a result of multiple pathogenic mechanisms. Vascular alterations, both of large arteries and at the microcirculation level, are strongly linked to the progression of chronic kidney disease, as well as renal, cardiac and cerebral complications and events.

In individuals at risk of developing chronic kidney disease, or in those who already suffer from it, the measurement of arterial stiffness and of atherosclerotic damage to the vascular wall is a central parameter for evaluation and one of the objectives to consider when designing preventive strategies against deterioration of target organs and events.

Keywords : chronic kidney disease; arterial stiffness; pulse wave velocity (PWV); ankle-arm systolic blood pressure index; subclinical atherosclerosis.

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