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World J Nephrol. Jan 6, 2016; 5(1): 90-100
Published online Jan 6, 2016. doi: 10.5527/wjn.v5.i1.90
Central blood pressure and chronic kidney disease
Yoichi Ohno, Yoshihiko Kanno, Tsuneo Takenaka
Yoichi Ohno, Department of Nephrology, Saitama Medical University, Saitama 350-0495, Japan
Yoshihiko Kanno, Department of Nephrology, Tokyo Medical University, Tokyo 160-0023, Japan
Tsuneo Takenaka, Department of Medicine, International University of Health and Welfare, Clinical Research Center, Sanno Hospital, Tokyo 107-0052, Japan
Author contributions: All authors equally contributed to this paper with conception and design of the study, acquisition and analysis of the data, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tsuneo Takenaka, MD, PhD, Department of Medicine, International University of Health and Welfare, Clinical Research Center, Sanno Hospital, 8-10-16 Akasaka Minato, Tokyo 107-0052, Japan. takenaka@iuhw.ac.jp
Telephone: +81-3-34023151 Fax: +81-3-34043652
Received: August 30, 2015
Peer-review started: August 31, 2015
First decision: October 27, 2015
Revised: November 17, 2015
Accepted: December 13, 2015
Article in press: December 14, 2015
Published online: January 6, 2016
Abstract

In this review, we focused on the relationship between central blood pressure and chronic kidney diseases (CKD). Wave reflection is a major mechanism that determines central blood pressure in patients with CKD. Recent medical technology advances have enabled non-invasive central blood pressure measurements. Clinical trials have demonstrated that compared with brachial blood pressure, central blood pressure is a stronger risk factor for cardiovascular (CV) and renal diseases. CKD is characterized by a diminished renal autoregulatory ability, an augmented direct transmission of systemic blood pressure to glomeruli, and an increase in proteinuria. Any elevation in central blood pressure accelerates CKD progression. In the kidney, interstitial inflammation induces oxidative stress to handle proteinuria. Oxidative stress facilitates atherogenesis, increases arterial stiffness and central blood pressure, and worsens the CV prognosis in patients with CKD. A vicious cycle exists between CKD and central blood pressure. To stop this cycle, vasodilator antihypertensive drugs and statins can reduce central blood pressure and oxidative stress. Even in early-stage CKD, mineral and bone disorders (MBD) may develop. MBD promotes oxidative stress, arteriosclerosis, and elevated central blood pressure in patients with CKD. Early intervention or prevention seems necessary to maintain vascular health in patients with CKD.

Keywords: Atherosclerosis, Mineral and bone disorder, Oxidative stress, Proteinuria, Renal autoregulation

Core tip: Wave reflection is a major mechanism that determines central blood pressure in chronic kidney disease (CKD). Diminished renal autoregulatory ability characterizes CKD, allowing an increase in proteinuria. Thus, any elevations of central blood pressure accelerate the progression of CKD. The kidney produces oxidative stress compounds due to proteinuria handling and secondary interstitial inflammation. Oxidative stress facilitates atherogenesis, increases arterial stiffness and central blood pressure. Furthermore, even in early stages of CKD, mineral and bone disorder (MBD) is developed. CKD-MBD facilitates to induce oxidative stress and elevation of central blood pressure. To keep vascular health in CKD, early intervention or prevention seems mandatory.