Effects of additional vasodilatory or nonvasodilatory treatment on renal function, vascular resistance and oxygenation in chronic kidney disease

a randomized clinical trial

Dinah S Khatir, Michael Pedersen, Per Ivarsen, Kent L Christensen, Bente Jespersen, Niels H Buus

Research output: Contribution to journalJournal articleResearchpeer-review

1 Citation (Scopus)

Abstract

Aim:Progression of chronic kidney disease (CKD) may be accelerated by tissue hypoxia due to impaired blood supply. This could be induced by small artery narrowing resulting in abnormally high intrarenal vascular resistance (RVR). We investigated whether a reduction in RVR achieved by adding vasodilating medical therapy (AVT) is superior to adding nonvasodilating medical therapy (AnonVT) regarding tissue oxygenation and preservation of kidney function.Methods:Eighty-three grade 3 and 4 CKD patients [estimated glomerular filtration rate (GFR) 34.6ml/min per 1.73m 2] were randomized to either AVT with amlodipine and/or renin angiotensin blockade or AnonVT with the nonvasodilating beta-blocker metoprolol. Investigations were performed at baseline and after 18 months of therapy. Systemic vasodilation was documented in the forearm vasculature using resting venous occlusion plethysmography. GFR was measured as 51Chrome-EDTA plasma clearance. Using MRI, renal artery blood flow was measured for calculation of RVR and for estimating renal oxygenation (R 2∗).Results:AVT and AnonVT achieved as planned similar blood pressure levels throughout the study. At follow-up, resistance had decreased by 7% (P<0.05) and RVR by 12% (P<0.05) in the AVT group, whereas in the AnonVT group, resistance increased by 39% (P<0.01), whereas RVR remained unchanged. At follow-up, no significant differences in cortical or medullary R 2∗ values between AVT and AnonVT were observed, and the GFR decline was similar in the two groups (3.0 vs. 3.3ml/min per 1.73m 2).Conclusion:Long-term intensified vasodilation treatment reduced peripheral and RVR, but this was not associated with improvement of R 2∗ or protection against loss of kidney function in CKD patients.

Original languageEnglish
JournalJournal of Hypertension
Volume37
Issue number1
Pages (from-to)116-124
Number of pages9
ISSN0263-6352
DOIs
Publication statusPublished - Jan 2019

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Chronic Renal Insufficiency
Vascular Resistance
Randomized Controlled Trials
Kidney
Glomerular Filtration Rate
Therapeutics
Group Psychotherapy
Vasodilation
Tissue Preservation
Amlodipine
Metoprolol
Plethysmography
Renal Circulation
Angiotensins
Renal Artery
Renin
Forearm
Edetic Acid
Arteries
Blood Pressure

Keywords

  • MRI
  • blood oxygen level dependent
  • renal artery blood flow
  • renal vascular resistance
  • vascular remodelling
  • vasodilation

Cite this

@article{e95c8ad5fd624f6a89073017a9a269ec,
title = "Effects of additional vasodilatory or nonvasodilatory treatment on renal function, vascular resistance and oxygenation in chronic kidney disease: a randomized clinical trial",
abstract = "Aim:Progression of chronic kidney disease (CKD) may be accelerated by tissue hypoxia due to impaired blood supply. This could be induced by small artery narrowing resulting in abnormally high intrarenal vascular resistance (RVR). We investigated whether a reduction in RVR achieved by adding vasodilating medical therapy (AVT) is superior to adding nonvasodilating medical therapy (AnonVT) regarding tissue oxygenation and preservation of kidney function.Methods:Eighty-three grade 3 and 4 CKD patients [estimated glomerular filtration rate (GFR) 34.6ml/min per 1.73m 2] were randomized to either AVT with amlodipine and/or renin angiotensin blockade or AnonVT with the nonvasodilating beta-blocker metoprolol. Investigations were performed at baseline and after 18 months of therapy. Systemic vasodilation was documented in the forearm vasculature using resting venous occlusion plethysmography. GFR was measured as 51Chrome-EDTA plasma clearance. Using MRI, renal artery blood flow was measured for calculation of RVR and for estimating renal oxygenation (R 2∗).Results:AVT and AnonVT achieved as planned similar blood pressure levels throughout the study. At follow-up, resistance had decreased by 7{\%} (P<0.05) and RVR by 12{\%} (P<0.05) in the AVT group, whereas in the AnonVT group, resistance increased by 39{\%} (P<0.01), whereas RVR remained unchanged. At follow-up, no significant differences in cortical or medullary R 2∗ values between AVT and AnonVT were observed, and the GFR decline was similar in the two groups (3.0 vs. 3.3ml/min per 1.73m 2).Conclusion:Long-term intensified vasodilation treatment reduced peripheral and RVR, but this was not associated with improvement of R 2∗ or protection against loss of kidney function in CKD patients.",
keywords = "MRI, blood oxygen level dependent, renal artery blood flow, renal vascular resistance, vascular remodelling, vasodilation",
author = "Khatir, {Dinah S} and Michael Pedersen and Per Ivarsen and Christensen, {Kent L} and Bente Jespersen and Buus, {Niels H}",
year = "2019",
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language = "English",
volume = "37",
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Effects of additional vasodilatory or nonvasodilatory treatment on renal function, vascular resistance and oxygenation in chronic kidney disease : a randomized clinical trial. / Khatir, Dinah S; Pedersen, Michael; Ivarsen, Per; Christensen, Kent L; Jespersen, Bente; Buus, Niels H.

In: Journal of Hypertension, Vol. 37, No. 1, 01.2019, p. 116-124.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Effects of additional vasodilatory or nonvasodilatory treatment on renal function, vascular resistance and oxygenation in chronic kidney disease

T2 - a randomized clinical trial

AU - Khatir, Dinah S

AU - Pedersen, Michael

AU - Ivarsen, Per

AU - Christensen, Kent L

AU - Jespersen, Bente

AU - Buus, Niels H

PY - 2019/1

Y1 - 2019/1

N2 - Aim:Progression of chronic kidney disease (CKD) may be accelerated by tissue hypoxia due to impaired blood supply. This could be induced by small artery narrowing resulting in abnormally high intrarenal vascular resistance (RVR). We investigated whether a reduction in RVR achieved by adding vasodilating medical therapy (AVT) is superior to adding nonvasodilating medical therapy (AnonVT) regarding tissue oxygenation and preservation of kidney function.Methods:Eighty-three grade 3 and 4 CKD patients [estimated glomerular filtration rate (GFR) 34.6ml/min per 1.73m 2] were randomized to either AVT with amlodipine and/or renin angiotensin blockade or AnonVT with the nonvasodilating beta-blocker metoprolol. Investigations were performed at baseline and after 18 months of therapy. Systemic vasodilation was documented in the forearm vasculature using resting venous occlusion plethysmography. GFR was measured as 51Chrome-EDTA plasma clearance. Using MRI, renal artery blood flow was measured for calculation of RVR and for estimating renal oxygenation (R 2∗).Results:AVT and AnonVT achieved as planned similar blood pressure levels throughout the study. At follow-up, resistance had decreased by 7% (P<0.05) and RVR by 12% (P<0.05) in the AVT group, whereas in the AnonVT group, resistance increased by 39% (P<0.01), whereas RVR remained unchanged. At follow-up, no significant differences in cortical or medullary R 2∗ values between AVT and AnonVT were observed, and the GFR decline was similar in the two groups (3.0 vs. 3.3ml/min per 1.73m 2).Conclusion:Long-term intensified vasodilation treatment reduced peripheral and RVR, but this was not associated with improvement of R 2∗ or protection against loss of kidney function in CKD patients.

AB - Aim:Progression of chronic kidney disease (CKD) may be accelerated by tissue hypoxia due to impaired blood supply. This could be induced by small artery narrowing resulting in abnormally high intrarenal vascular resistance (RVR). We investigated whether a reduction in RVR achieved by adding vasodilating medical therapy (AVT) is superior to adding nonvasodilating medical therapy (AnonVT) regarding tissue oxygenation and preservation of kidney function.Methods:Eighty-three grade 3 and 4 CKD patients [estimated glomerular filtration rate (GFR) 34.6ml/min per 1.73m 2] were randomized to either AVT with amlodipine and/or renin angiotensin blockade or AnonVT with the nonvasodilating beta-blocker metoprolol. Investigations were performed at baseline and after 18 months of therapy. Systemic vasodilation was documented in the forearm vasculature using resting venous occlusion plethysmography. GFR was measured as 51Chrome-EDTA plasma clearance. Using MRI, renal artery blood flow was measured for calculation of RVR and for estimating renal oxygenation (R 2∗).Results:AVT and AnonVT achieved as planned similar blood pressure levels throughout the study. At follow-up, resistance had decreased by 7% (P<0.05) and RVR by 12% (P<0.05) in the AVT group, whereas in the AnonVT group, resistance increased by 39% (P<0.01), whereas RVR remained unchanged. At follow-up, no significant differences in cortical or medullary R 2∗ values between AVT and AnonVT were observed, and the GFR decline was similar in the two groups (3.0 vs. 3.3ml/min per 1.73m 2).Conclusion:Long-term intensified vasodilation treatment reduced peripheral and RVR, but this was not associated with improvement of R 2∗ or protection against loss of kidney function in CKD patients.

KW - MRI

KW - blood oxygen level dependent

KW - renal artery blood flow

KW - renal vascular resistance

KW - vascular remodelling

KW - vasodilation

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U2 - 10.1097/HJH.0000000000001835

DO - 10.1097/HJH.0000000000001835

M3 - Journal article

VL - 37

SP - 116

EP - 124

JO - Journal of Hypertension

JF - Journal of Hypertension

SN - 0263-6352

IS - 1

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