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Neointimal Hyperplasia and Calcification in Medium Sized Arteries in Adult Patients with Chronic Kidney Disease
Author(s) -
Chitalia Nihil,
Ross Louise,
Krishnamoorthy Mahesh,
Kapustin Alexander,
Shanahan Catherine M,
Kaski Juan Carlos,
RoyChaudhury Prabir,
Chemla Eric,
Banerjee Debasish
Publication year - 2014
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/sdi.12335
Subject(s) - medicine , intimal hyperplasia , arterial stiffness , dialysis , cardiology , kidney disease , hemodialysis , brachial artery , hyperplasia , artery , calcification , urology , blood pressure , smooth muscle
The nature of arterial changes resulting in cardiovascular events and dialysis vascular access failures in adult predialysis patients is not well known. This study examined intimal changes, calcium deposition, and consequent stiffness in brachial and radial arteries of adult CKD patients. Ten brachial‐artery and seven radial‐artery specimens were obtained during fistula creation from nine predialysis and eight dialysis‐dependent, nondiabetic patients; and age‐gender matched controls undergoing coronary bypass grafts (6 radial) or kidney donation (6 renal). Arterial stiffness was measured at baseline. Vessel histology, morphometric analysis of intima‐media, and direct quantification of calcium load was performed using standard techniques. Both predialysis and dialysis patients demonstrated significant arterial intimal hyperplasia with intima:media ratio higher than controls (0.13 ± 0.12 vs. 0.02 ± 0.05, p = 0.01). Calcium deposition was demonstrated on histology and the calcium content in patients was higher than controls (34.68 ± 26.86 vs. 10.95 ± 9.18 μg/μg, p = 0.003). The blood vessel calcium content correlated with arterial stiffness ( r = 0.64, p = 0.018). This study for the first time describes, and suggests mechanistic linkage between, intimal hyperplasia, pathological calcium deposition, and increased functional arterial stiffness in dialysis and predialysis patients. Our research could serve as a unique window into the in vivo status of the uremic vasculature impacting fistula maturation and cardiovascular disease.