Coronary microvascular dysfunction is associated with degree of anaemia in end stage renal disease

Ashwin Radhakrishnan; Luke Pickup; Anna Price; Jonathan Law; Kirsty McGee; Larissa Fabritz; Roxy  Senior; Richard Steeds; Charles Ferro; Jon Townend

doi:10.1186/s12872-021-02025-2

Coronary microvascular dysfunction is associated with degree of anaemia in end stage renal disease

Ashwin Radhakrishnan, Luke Pickup, Anna Price, Jonathan Law, Kirsty McGee, Larissa Fabritz, Roxy Senior, Richard Steeds, Charles Ferro, Jon Townend

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Abstract

Background: Coronary microvascular dysfunction (CMD) is common in end-stage renal disease (ESRD) and is an adverse prognostic marker. Coronary flow velocity reserve (CFVR) is a measure of coronary microvascular function and can be assessed using Doppler echocardiography. Reduced CFVR in ESRD has been attributed to factors such as diabetes, hypertension and left ventricular hypertrophy. The contributory role of other mediators important in the development of cardiovascular disease in ESRD has not been studied. The aim of this study was to examine the prevalence of CMD in a cohort of kidney transplant candidates and to look for associations of CMD with markers of anaemia, bone mineral metabolism and chronic inflammation.

Methods: Twenty-two kidney transplant candidates with ESRD were studied with myocardial contrast echocardiography, Doppler CFVR assessment and serum multiplex immunoassay analysis. Individuals with diabetes, uncontrolled hypertension or ischaemic heart disease were excluded.

Results: 7/22 subjects had CMD (defined as CFVR < 2). Demographic, laboratory and echocardiographic parameters and serum biomarkers were similar between subjects with and without CMD. Subjects with CMD had significantly lower haemoglobin than subjects without CMD (102 g/L ± 12 vs. 117 g/L ± 11, p = 0.008). There was a positive correlation between haemoglobin and CFVR (r = 0.7, p = 0.001). Similar results were seen for haematocrit. In regression analyses, haemoglobin was an independent predictor of CFVR (β = 0.041 95% confidence interval 0.012–0.071, p = 0.009) and of CFVR < 2 (odds ratio 0.85 95% confidence interval 0.74–0.98, p = 0.022).

Conclusions: Among kidney transplant candidates with ESRD, there is a high prevalence of CMD, despite the absence of traditional risk factors. Anaemia may be a potential driver of microvascular dysfunction in this population and requires further investigation.

Original language	English
Article number	211
Number of pages	9
Journal	BMC Cardiovascular Disorders
Volume	21
Issue number	1
Early online date	26 Apr 2021
DOIs	https://doi.org/10.1186/s12872-021-02025-2
Publication status	Published - Dec 2021

Bibliographical note

Funding Information:
The CRIB-FLOW study was funded by research grants from University Hospitals Birmingham Charity and the Metchley Park Medical Society. The RETRACT study was funded by a British Heart Foundation Clinical Research Training Fellowship (FS/18/29/33554) awarded to LCP. AMP and JPL are also holders of British Heart Foundation Clinical Research Training Fellowships (FS/16/73/32314 and FS/19/16/34169 respectively). LF has received support via the Institute of Cardiovascular Sciences, University of Birmingham: Fondation Leducq & British Heart Foundation Accelerator Award (AA/18/2/34218).

Funding Information:
LF has received institutional research grants and non-financial support from the European Union, British Heart Foundation, Medical Research Council (UK), DFG and several biomedical companies. LF is listed as an inventor on two patents held by the University of Birmingham (Atrial Fibrillation Therapy WO 2015140571, Markers for Atrial Fibrillation WO 2016012783). No other authors have any competing interests to declare.

Publisher Copyright:
© 2021, The Author(s).

Keywords

Anaemia
Coronary flow velocity reserve
Coronary microvascular dysfunction
End-stage renal disease

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

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title = "Coronary microvascular dysfunction is associated with degree of anaemia in end stage renal disease",

abstract = "Background: Coronary microvascular dysfunction (CMD) is common in end-stage renal disease (ESRD) and is an adverse prognostic marker. Coronary flow velocity reserve (CFVR) is a measure of coronary microvascular function and can be assessed using Doppler echocardiography. Reduced CFVR in ESRD has been attributed to factors such as diabetes, hypertension and left ventricular hypertrophy. The contributory role of other mediators important in the development of cardiovascular disease in ESRD has not been studied. The aim of this study was to examine the prevalence of CMD in a cohort of kidney transplant candidates and to look for associations of CMD with markers of anaemia, bone mineral metabolism and chronic inflammation. Methods: Twenty-two kidney transplant candidates with ESRD were studied with myocardial contrast echocardiography, Doppler CFVR assessment and serum multiplex immunoassay analysis. Individuals with diabetes, uncontrolled hypertension or ischaemic heart disease were excluded. Results: 7/22 subjects had CMD (defined as CFVR < 2). Demographic, laboratory and echocardiographic parameters and serum biomarkers were similar between subjects with and without CMD. Subjects with CMD had significantly lower haemoglobin than subjects without CMD (102 g/L ± 12 vs. 117 g/L ± 11, p = 0.008). There was a positive correlation between haemoglobin and CFVR (r = 0.7, p = 0.001). Similar results were seen for haematocrit. In regression analyses, haemoglobin was an independent predictor of CFVR (β = 0.041 95% confidence interval 0.012–0.071, p = 0.009) and of CFVR < 2 (odds ratio 0.85 95% confidence interval 0.74–0.98, p = 0.022). Conclusions: Among kidney transplant candidates with ESRD, there is a high prevalence of CMD, despite the absence of traditional risk factors. Anaemia may be a potential driver of microvascular dysfunction in this population and requires further investigation.",

keywords = "Anaemia, Coronary flow velocity reserve, Coronary microvascular dysfunction, End-stage renal disease",

author = "Ashwin Radhakrishnan and Luke Pickup and Anna Price and Jonathan Law and Kirsty McGee and Larissa Fabritz and Roxy Senior and Richard Steeds and Charles Ferro and Jon Townend",

note = "Funding Information: The CRIB-FLOW study was funded by research grants from University Hospitals Birmingham Charity and the Metchley Park Medical Society. The RETRACT study was funded by a British Heart Foundation Clinical Research Training Fellowship (FS/18/29/33554) awarded to LCP. AMP and JPL are also holders of British Heart Foundation Clinical Research Training Fellowships (FS/16/73/32314 and FS/19/16/34169 respectively). LF has received support via the Institute of Cardiovascular Sciences, University of Birmingham: Fondation Leducq & British Heart Foundation Accelerator Award (AA/18/2/34218). Funding Information: LF has received institutional research grants and non-financial support from the European Union, British Heart Foundation, Medical Research Council (UK), DFG and several biomedical companies. LF is listed as an inventor on two patents held by the University of Birmingham (Atrial Fibrillation Therapy WO 2015140571, Markers for Atrial Fibrillation WO 2016012783). No other authors have any competing interests to declare. Publisher Copyright: {\textcopyright} 2021, The Author(s).",

year = "2021",

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doi = "10.1186/s12872-021-02025-2",

language = "English",

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T1 - Coronary microvascular dysfunction is associated with degree of anaemia in end stage renal disease

AU - Radhakrishnan, Ashwin

AU - Pickup, Luke

AU - Price, Anna

AU - Law, Jonathan

AU - McGee, Kirsty

AU - Fabritz, Larissa

AU - Senior, Roxy

AU - Steeds, Richard

AU - Ferro, Charles

AU - Townend, Jon

N1 - Funding Information: The CRIB-FLOW study was funded by research grants from University Hospitals Birmingham Charity and the Metchley Park Medical Society. The RETRACT study was funded by a British Heart Foundation Clinical Research Training Fellowship (FS/18/29/33554) awarded to LCP. AMP and JPL are also holders of British Heart Foundation Clinical Research Training Fellowships (FS/16/73/32314 and FS/19/16/34169 respectively). LF has received support via the Institute of Cardiovascular Sciences, University of Birmingham: Fondation Leducq & British Heart Foundation Accelerator Award (AA/18/2/34218). Funding Information: LF has received institutional research grants and non-financial support from the European Union, British Heart Foundation, Medical Research Council (UK), DFG and several biomedical companies. LF is listed as an inventor on two patents held by the University of Birmingham (Atrial Fibrillation Therapy WO 2015140571, Markers for Atrial Fibrillation WO 2016012783). No other authors have any competing interests to declare. Publisher Copyright: © 2021, The Author(s).

PY - 2021/12

Y1 - 2021/12

N2 - Background: Coronary microvascular dysfunction (CMD) is common in end-stage renal disease (ESRD) and is an adverse prognostic marker. Coronary flow velocity reserve (CFVR) is a measure of coronary microvascular function and can be assessed using Doppler echocardiography. Reduced CFVR in ESRD has been attributed to factors such as diabetes, hypertension and left ventricular hypertrophy. The contributory role of other mediators important in the development of cardiovascular disease in ESRD has not been studied. The aim of this study was to examine the prevalence of CMD in a cohort of kidney transplant candidates and to look for associations of CMD with markers of anaemia, bone mineral metabolism and chronic inflammation. Methods: Twenty-two kidney transplant candidates with ESRD were studied with myocardial contrast echocardiography, Doppler CFVR assessment and serum multiplex immunoassay analysis. Individuals with diabetes, uncontrolled hypertension or ischaemic heart disease were excluded. Results: 7/22 subjects had CMD (defined as CFVR < 2). Demographic, laboratory and echocardiographic parameters and serum biomarkers were similar between subjects with and without CMD. Subjects with CMD had significantly lower haemoglobin than subjects without CMD (102 g/L ± 12 vs. 117 g/L ± 11, p = 0.008). There was a positive correlation between haemoglobin and CFVR (r = 0.7, p = 0.001). Similar results were seen for haematocrit. In regression analyses, haemoglobin was an independent predictor of CFVR (β = 0.041 95% confidence interval 0.012–0.071, p = 0.009) and of CFVR < 2 (odds ratio 0.85 95% confidence interval 0.74–0.98, p = 0.022). Conclusions: Among kidney transplant candidates with ESRD, there is a high prevalence of CMD, despite the absence of traditional risk factors. Anaemia may be a potential driver of microvascular dysfunction in this population and requires further investigation.

AB - Background: Coronary microvascular dysfunction (CMD) is common in end-stage renal disease (ESRD) and is an adverse prognostic marker. Coronary flow velocity reserve (CFVR) is a measure of coronary microvascular function and can be assessed using Doppler echocardiography. Reduced CFVR in ESRD has been attributed to factors such as diabetes, hypertension and left ventricular hypertrophy. The contributory role of other mediators important in the development of cardiovascular disease in ESRD has not been studied. The aim of this study was to examine the prevalence of CMD in a cohort of kidney transplant candidates and to look for associations of CMD with markers of anaemia, bone mineral metabolism and chronic inflammation. Methods: Twenty-two kidney transplant candidates with ESRD were studied with myocardial contrast echocardiography, Doppler CFVR assessment and serum multiplex immunoassay analysis. Individuals with diabetes, uncontrolled hypertension or ischaemic heart disease were excluded. Results: 7/22 subjects had CMD (defined as CFVR < 2). Demographic, laboratory and echocardiographic parameters and serum biomarkers were similar between subjects with and without CMD. Subjects with CMD had significantly lower haemoglobin than subjects without CMD (102 g/L ± 12 vs. 117 g/L ± 11, p = 0.008). There was a positive correlation between haemoglobin and CFVR (r = 0.7, p = 0.001). Similar results were seen for haematocrit. In regression analyses, haemoglobin was an independent predictor of CFVR (β = 0.041 95% confidence interval 0.012–0.071, p = 0.009) and of CFVR < 2 (odds ratio 0.85 95% confidence interval 0.74–0.98, p = 0.022). Conclusions: Among kidney transplant candidates with ESRD, there is a high prevalence of CMD, despite the absence of traditional risk factors. Anaemia may be a potential driver of microvascular dysfunction in this population and requires further investigation.

KW - Anaemia

KW - Coronary flow velocity reserve

KW - Coronary microvascular dysfunction

KW - End-stage renal disease

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U2 - 10.1186/s12872-021-02025-2

DO - 10.1186/s12872-021-02025-2

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JO - BMC Cardiovascular Disorders

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ER -

Coronary microvascular dysfunction is associated with degree of anaemia in end stage renal disease

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

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