{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T04:42:13Z","timestamp":1792644133272,"version":"4.5.0"},"reference-count":113,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JASN"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:p>\n                    CKD frequently leads to chronic cardiac dysfunction. This complex relationship has been termed as cardiorenal syndrome type 4 or cardio-renal link. Despite numerous studies and reviews focused on the pathophysiology and therapy of this syndrome, the role of arterial stiffness has been frequently overlooked. In this regard, several pathogenic factors, including uremic toxins (\n                    <jats:italic toggle=\"yes\">i.e.<\/jats:italic>\n                    , uric acid, phosphates, endothelin-1, advanced glycation end-products, and asymmetric dimethylarginine), can be involved. Their effect on the arterial wall, direct or mediated by chronic inflammation and oxidative stress, results in arterial stiffening and decreased vascular compliance. The increase in aortic stiffness results in increased cardiac workload and reduced coronary artery perfusion pressure that, in turn, may lead to microvascular cardiac ischemia. Conversely, reduced arterial stiffness has been associated with increased survival. Several approaches can be considered to reduce vascular stiffness and improve vascular function in patients with CKD. This review primarily discusses current understanding of the mechanisms concerning uremic toxins, arterial stiffening, and impaired cardiac function, and the therapeutic options to reduce arterial stiffness in patients with CKD.\n                  <\/jats:p>","DOI":"10.1681\/asn.2019020117","type":"journal-article","created":{"date-parts":[[2019,4,30]],"date-time":"2019-04-30T17:34:32Z","timestamp":1556645672000},"page":"918-928","source":"Crossref","is-referenced-by-count":198,"title":["Arterial Stiffness in the Heart Disease of CKD"],"prefix":"10.1681","volume":"30","author":[{"given":"Luca","family":"Zanoli","sequence":"first","affiliation":[{"name":"Sections of Nephrology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Lentini","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Dialysis, St. Bassiano Hospital, Bassano del Grappa, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Briet","sequence":"additional","affiliation":[{"name":"Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale U1083, National Center for Scientific Research Joint Research Unit 6214, Centre Hospitalo-Universitaire d\u2019Angers, Universit\u00e9 d\u2019Angers, Angers, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Castellino","sequence":"additional","affiliation":[{"name":"Internal Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew A.","family":"House","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Western Ontario, London, Ontario, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard M.","family":"London","sequence":"additional","affiliation":[{"name":"Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale U970, Paris, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Malatino","sequence":"additional","affiliation":[{"name":"Internal Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter A.","family":"McCullough","sequence":"additional","affiliation":[{"name":"Department of Medicine, Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitri P.","family":"Mikhailidis","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry, University College London, London, UK;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Boutouyrie","sequence":"additional","affiliation":[{"name":"Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale U970, Paris, France;"},{"name":"Facult\u00e9 de M\u00e9decine, Universit\u00e9 Paris Descartes, Sorbonne Paris Cit\u00e9, Paris, France; and"},{"name":"Department of Pharmacology, H\u00f4pital Europ\u00e9en Georges-Pompidou, Assistance Publique\u2013H\u00f4pitaux de Paris, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,4,30]]},"reference":[{"key":"B1-20230929","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ejim.2016.02.019","article-title":"Cardiorenal syndrome type 4: From chronic kidney disease to cardiovascular impairment","volume":"30","author":"Granata","year":"2016","journal-title":"Eur J Intern Med"},{"key":"B3-20230929","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/j.ijcard.2012.09.026","article-title":"Incorporating glomerular filtration rate or creatinine clearance by the modification of diet in renal disease equation or the Cockcroft-Gault equations to improve the global accuracy of the Age, Creatinine, Ejection Fraction [ACEF] score in patients undergoing percutaneous coronary intervention","volume":"168","author":"Capodanno","year":"2013","journal-title":"Int J Cardiol"},{"key":"B4-20230929","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/j.atherosclerosis.2015.05.007","article-title":"The role of vascular biomarkers for primary and secondary prevention. 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