Increased adiposity impairs vascular function in postmenopausal women in hemodialysis

Abstract

This study examines the impact of increased body fat on vascular function in postmenopausal women and old men with chronic kidney disease (CKD) undergoing hemodialysis. We included 34 postmenopausal women with CKD under hemodialysis (PMW-CKD-HDys) and 31 age-matched men with CKD also under hemodialysis (M-CKD-HDys). We assessed blood pressure and endothelial function (EFn) through measurements of flow-mediated dilation (FMD). We also evaluated systolic and diastolic blood pressure (SBP and DBP), body mass index (BMI), fat total index (FTI), and lean total index (LTI). A subgroup of patients with CKD-HDys infected with COVID 19 were also evaluated on their endothelial function. Our findings indicate that SBP was significantly higher in M-CKD-HDys (149 ± 2 mmHg) than in PMW-CKD-HDys (141 ± 3 mmHg; P < 0.05), whereas EFn was similar in both groups. We observed a negative correlation between endothelial function and FTI only in PMW-CKD-HDys, where an increased adipose tissue negatively correlated with a reduced endothelial function. Interestingly, this endothelial function finding suggests a worse effect on PMM-CKD-HDys, considering that, in general, healthy women have better EFn than healthy men. In addition, a subgroup of patients who contracted COVID-19 exhibited further deterioration in EFn. The results underscore the critical role of body fat in influencing vascular health in this high-risk population, indicating that interventions aimed at weight management could be pivotal in improving cardiovascular outcomes for postmenopausal women with CKD. These findings highlight the need for tailored therapeutic strategies to enhance endothelial function and overall cardiovascular health in patients with CKD, particularly those postmenopausal women with increased adipose tissue undergoing hemodialysis.