American Journal of Kidney Diseases
Volume 52, Issue 5 , Pages 859-867, November 2008

Relations of Measures of Endothelial Function and Kidney Disease: The Framingham Heart Study

  • Meredith C. Foster, MPH

      Affiliations

    • The National Heart, Lung, and Blood Institute Framingham Heart Study, Framingham, MA
    • National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
  • ,
  • Michelle J. Keyes, PhD

      Affiliations

    • The National Heart, Lung, and Blood Institute Framingham Heart Study, Framingham, MA
  • ,
  • Martin G. Larson, ScD

      Affiliations

    • The National Heart, Lung, and Blood Institute Framingham Heart Study, Framingham, MA
  • ,
  • Joseph A. Vita, MD

      Affiliations

    • Cardiology Section, Boston University, Boston, MA
    • Whitaker Cardiovascular Institute School of Medicine, Boston University, Boston, MA
  • ,
  • Gary F. Mitchell, MD

      Affiliations

    • Cardiovascular Engineering Inc, Waltham, MA
  • ,
  • James B. Meigs, MD, MPH

      Affiliations

    • Harvard Medical School and Massachusetts General Hospital Division of General Internal Medicine, Boston, MA
  • ,
  • Ramachandran S. Vasan, MD

      Affiliations

    • The National Heart, Lung, and Blood Institute Framingham Heart Study, Framingham, MA
    • Cardiology Section, Boston University, Boston, MA
    • Whitaker Cardiovascular Institute School of Medicine, Boston University, Boston, MA
    • Preventive Medicine Section, Boston University, Boston, MA
  • ,
  • Emelia J. Benjamin, MD, ScM

      Affiliations

    • The National Heart, Lung, and Blood Institute Framingham Heart Study, Framingham, MA
    • Cardiology Section, Boston University, Boston, MA
    • Whitaker Cardiovascular Institute School of Medicine, Boston University, Boston, MA
    • Preventive Medicine Section, Boston University, Boston, MA
    • School of Public Health, Boston University, Boston, MA
  • ,
  • Caroline S. Fox, MD, MPH

      Affiliations

    • The National Heart, Lung, and Blood Institute Framingham Heart Study, Framingham, MA
    • National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
    • Brigham and Women's Hospital, Harvard Medical School, Boston, MA
    • Corresponding Author InformationAddress correspondence to Caroline S. Fox, MD, MPH, NHLBI's Framingham Heart Study, 73 Mt Wayte Ave, Ste 2, Framingham, MA 01702

Received 26 September 2007; accepted 15 April 2008. published online 10 July 2008.

Background

Endothelial dysfunction is prevalent in individuals with end-stage renal disease. Whether endothelial dysfunction is present in patients with moderate chronic kidney disease (CKD) is uncertain.

Study Design

Cross-sectional study.

Settings & Participants

Brachial reactivity measurements were obtained during the seventh examination cycle in 2,818 (diameter measurements) and 2,256 (flow measurements) Framingham Heart Study Offspring cohort participants (53% women; mean age, 61 ± 9 years).

Predictor

Estimated glomerular filtration rate less than 60 mL/min/1.73 m2 derived from creatinine- and cystatin C–based estimating equations; microalbuminuria status.

Outcome

Brachial reactivity measurements (baseline brachial diameter, flow-mediated dilation, baseline and hyperemic mean flow).

Measurements

Linear regression models were used to model brachial measures as a function of CKD and microalbuminuria status.

Results

Overall, 7.3% (n = 206) of participants had CKD, and of 2,301 with urinary measurements, 10.0% (n = 230) had microalbuminuria. Brachial reactivity measures did not differ significantly by CKD status in either creatinine- or cystatin C–based equations in either age- and sex- or multivariable-adjusted models. In age- and sex-adjusted models, microalbuminuria was associated with decreased hyperemic mean flow (47.2 ± 1.4 versus 51.4 ± 0.5 mg/g; P = 0.005), but the association was not significant after multivariable adjustment (P = 0.09).

Limitations

Predominantly white ambulatory cohort; results may not be generalizable to other ethnic groups or individuals with severe CKD.

Conclusions

Endothelial dysfunction was not a major correlate of CKD in our sample.

Index Words: Chronic kidney disease, brachial reactivity, cystatin C, Framingham Heart Study

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 Originally published online as doi:10.1053/j.ajkd.2008.04.027 on July 10, 2008.

 E.J.B. and C.S.F. contributed equally to this work.

PII: S0272-6386(08)00887-1

doi:10.1053/j.ajkd.2008.04.027

American Journal of Kidney Diseases
Volume 52, Issue 5 , Pages 859-867, November 2008