Radhakrishnan, Ashwin (2022). Coronary microvascular dysfunction in chronic kidney disease – insights from living kidney donors and end-stage renal disease. University of Birmingham. M.D.
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Radhakrishnan2022MD.pdf
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Abstract
Cardiovascular disease is the leading cause of morbidity and mortality among patients with chronic kidney disease (CKD). This risk is highest in patients with uraemic cardiomyopathy - a clinical syndrome characterised by left ventricular hypertrophy, myocardial fibrosis, systolic and diastolic dysfunction and an increased risk of sudden cardiac death. Uraemic cardiomyopathy shares similarities with other myocardial diseases such as heart failure with preserved ejection fraction, which are associated with a high burden of coronary microvascular dysfunction (CMD).
In this thesis I explore the prevalence and mechanisms of CMD in different populations with renal impairment. I have identified several novel findings. Firstly, I have shown that living kidney donors have reduced coronary flow velocity reserve (CFVR – a measure of coronary microvascular function) and increased inflammatory markers compared to healthy controls, suggesting that uni-nephrectomy and its associated loss of renal function may lead to subclinical inflammation and microvascular changes. Secondly, I have demonstrated a high prevalence of CMD among patients with CKD stage 5 that are on the kidney transplant waiting list, with lower CFVR among patients with more profound anaemia. Finally, I have shown a negative correlation between CFVR and T1 times (a marker of myocardial fibrosis) in patients with advanced CKD.
These findings suggest that CMD may be a key contributor to the cardiovascular risk associated with renal dysfunction. Larger studies are necessary to confirm the findings shown in these cross-sectional data.
| Type of Work: | Thesis (Doctorates > M.D.) | |||||||||
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| Award Type: | Doctorates > M.D. | |||||||||
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| Licence: | All rights reserved | |||||||||
| College/Faculty: | Colleges (2008 onwards) > College of Medical & Dental Sciences | |||||||||
| School or Department: | Institute of Cardiovascular Sciences | |||||||||
| Funders: | Other | |||||||||
| Other Funders: | Metchley Park Medical Society, University Hospitals Birmingham Charity | |||||||||
| Subjects: | R Medicine > R Medicine (General) | |||||||||
| URI: | http://etheses.bham.ac.uk/id/eprint/12402 |
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