Endothelial Dysfunction Is Associated with Cerebrovascular Events in Pre-Dialysis CKD Patients: A Prospective Study

Abstract

In the CKD patient population, the mean age was 57.7 ± 15.5 years, the mean eGFR was 54.9 ± 36.7 mL/min/1.73 m² (CKD-EPI) and 57 were males (47.5%). At baseline, in univariate analysis, RHI in the CKD group correlated positively with eGFR (r = 0.332, <i>p</i> < 0.0001) and correlated negatively with age (r = -0.469, <i>p</i> < 0.0001), Charlson index (r = -0.399, <i>p</i> < 0.0001), systolic blood pressure (r = -0.256, <i>p</i> = 0.005), and proteinuria (r = 0.211, <i>p</i> = 0.027). Reactive hyperemia index in the control group did not significantly differ from RHI observed in patients with CKD stages 1 to 5 (2.09 ± 0.40 vs. 2.01 ± 0.06, <i>p</i> = 0.493). In adjusted analysis, only age (β = -0.014, <i>p</i> = 0.003) remained independently associated with RHI at baseline. During follow-up, 8 patients suffered a MACCEs, 33 patients experienced renal function deterioration, 17 patients were hospitalized for medical reasons and 6 patients died. RHI at baseline was not significantly associated with CKD progression (1.94 vs. 2.02, <i>p</i> = 0.584), hospitalizations (1.90 vs. 2.04, <i>p</i> = 0.334), and all-cause mortality (1.65 vs. 2.01, <i>p</i> = 0.208) or MACCEs (1.77 vs. 2.01, <i>p</i> = 0.356), but was significantly associated with cerebrovascular events (1.27 vs. 2.02, <i>p</i> = 0.004) and with a composite cardiovascular outcome (MACCEs, hospital admissions and death; 1.73 vs. 2.07, <i>p</i> = 0.035). <b>Conclusion:</b> Our results suggest that RHI may be a predictor for the development of cerebrovascular events in pre-dialysis CKD patients who may benefit from more aggressive preventive measures.