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

Research output: Contribution to journalArticlepeer-review


  • Ashwin Radhakrishnan
  • Anna Price
  • Roxy Senior
  • Richard Steeds
  • Charles Ferro

Colleges, School and Institutes


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.

Bibliographic 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).


Original languageEnglish
Article number211
Number of pages9
JournalBMC Cardiovascular Disorders
Issue number1
Early online date26 Apr 2021
Publication statusE-pub ahead of print - 26 Apr 2021


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

Sustainable Development Goals