Patient characteristics rather than the type of dialyser predict the variability of endothelial derived surface molecules in chronic haemodialysis patients (original) (raw)
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Dialysis improves endothelial function in humans
Nephrology Dialysis Transplantation, 2001
Background. Circulating inhibitors of endothelial function have been implicated in the pathogenesis of vascular disease in chronic renal failure. The aim of this study was to determine if lowering the plasma concentration of these and other dialysable toxins improves endothelial function. To do this we compared the acute effects on endothelial function of single episodes of haemodialysis with automated peritoneal dialysis. We hypothesized that endothelial function would improve after dialysis, with a greater effect seen after haemodialysis due to more substantial clearance of endothelial toxins per-treatment. Methods. Subjects with end-stage renal failure undergoing haemodialysis (ns16) or automated peritoneal dialysis (ns14) were investigated. Endothelial function was determined using vascular ultrasound to measure¯ow-mediated dilatation of the brachial artery and was compared with the dilatation caused by sublingual glyceryl trinitrate. Endothelial function was assessed before and after a single dialysis treatment. Plasma concentrations of the inhibitors of endothelial function, asymmetric dimethyl-L-arginine and homocysteine were measured. Flow-mediated dilatation was expressed as percentage change from basal diameter and analysed using Student's t test. Results. The plasma concentration of circulating inhibitors of endothelial function was reduced after haemodialysis but not peritoneal dialysis. Haemodialysis increased¯ow-mediated dilatation from 4.0"1.0% to 5.8"1.2% (P-0.002). These changes persisted for 5 h but returned to baseline by 24 h. Automated peritoneal dialysis had no acute effect on ow-mediated dilatation (5.9"1.1% vs 5.4"0.8% after, P)0.5). There were no effects of either dialysis modality on dilatation to glyceryl trinitrate. Conclusions. Short-term reduction of circulating inhibitors of endothelial function by haemodialysis is associated with increased¯ow-mediated dilatation. These data suggest that dialysable endothelial toxins have deleterious effects on endothelial function that are rapidly reversible.
American Journal of Kidney Diseases, 2005
Background: Vascular cell adhesion molecule 1 (VCAM-1) is involved in leukocyte-endothelial cell interaction and has a pivotal role in inflammation. Whether it contributes to excessive mortality in dialysis patients remains uncertain. In this study, we examined circulating soluble VCAM-1 (sVCAM-1) in relation to different clinical and biochemical parameters, as well as mortality and cardiovascular events, in peritoneal dialysis (PD) patients. Methods: Values for serum sVCAM-1, together with C-reactive protein (CRP), homocysteine, albumin, lipid profile, blood hemoglobin, and indices of dialysis adequacy, were determined at study baseline, and echocardiography was performed in 160 long-term PD patients. Patients were followed up for a mean of 35 ؎ 16 (SD) months. Results: Serum sVCAM-1 levels were elevated in our continuous ambulatory PD (CAPD) patients and showed a negative correlation with residual glomerular filtration rate (GFR; P < 0.001) and low-density lipoprotein (LDL) cholesterol level (P ؍ 0.004), but a positive correlation with left ventricular mass index (P ؍ 0.025). Using Kaplan-Meier analysis, overall survival rates at 2 years were 96.2%, 75.2%, and 50.6% for patients in the lower, middle, and upper tertiles of sVCAM-1 levels, respectively (P < 0.0001). Fatal and nonfatal cardiovascular event-free survival rates were 58.2%, 56.9%, and 19.4% for patients in the lower, middle, and upper tertiles, respectively (P < 0.0001). Using Cox regression analysis with adjustment for confounding covariates, every 100-ng/mL increase in sVCAM-1 level was associated with 8% (95% confidence interval, 1.03 to 1.13) and 5% (95% confidence interval, 1.00 to 1.10) increases in risk for death and fatal and nonfatal cardiovascular events, respectively. Its significance for all-cause mortality remained with additional adjusting for LDL cholesterol level, but was lost when adjusting for residual GFR. Its association with cardiovascular events became insignificant when adjusting for LDL cholesterol level or residual GFR. Furthermore, patients with both sVCAM-1 and CRP levels elevated at the 50th percentile or greater were associated with the greatest death and fatal and nonfatal cardiovascular event rates compared with those with either CRP or sVCAM-1 level elevated at the 50th percentile or greater. Conclusion: Circulating sVCAM-1 levels show an important link with residual renal function, LDL cholesterol level, and cardiac hypertrophy in CAPD patients. Furthermore, residual renal function, which correlates inversely with circulating sVCAM-1 level, shows an important association with all-cause mortality and cardiovascular events and displaces sVCAM-1 level from the models for all-cause mortality and future cardiovascular events in CAPD patients. Additional study is needed to explore possible mechanistic links between inflammation, soluble adhesion molecules, residual renal function, and cardiac hypertrophy in CAPD patients. Am J Kidney Dis 45:715-729.
Blood Purification, 2014
Inflammation is a common entity among chronic renal failure (CRF) patients. Neutrophil gelatinase-associated lipocalin (NGAL) is a member of lipocalin family and released from many tissues and cells. We aimed to investigate the relationship between serum NGAL levels and the inflammation markers such as high sensitive CRP (hs-CRP), Interleukin-6 (IL-6) and Tumor Necrosis Factor-Alpha (TNF-α) with different vascular access types used in dialysis patients. Methods: The study population included 90 patients and 30 healthy age-matched controls. The patients were divided into three groups (I, II, III) and group IV included the controls. In group I and II the patients were with central venous permanent catheter (CVPC) and arterio-venous fistula (AVF) respectively. Group III included 30 patients with CRF. Hemogram, biochemical assays, ferritin, IL-6, hs-CRP, TNF-α and NGAL were evaluated in all groups. Results: Serum NGAL levels were markedly higher in HD patients with CVPC than in with AVF (7645.80±924.61 vs 4131.20±609.87 pg/ml; p < 0.05). Positive correlation were detected between NGAL levels and duration of CVPC (r = 0.73, p = 0.000), TNF-α (r = 0.57, p = 0.00), hs-CRP (r = 0.80, p = 0.00), IL-6 levels (r = 0.691, p = 0.00) and ferritin (r = 0.32, p = 0.01), whereas serum NGAL levels were negatively correlated with serum albumin levels (r =-0.49, p = 0.00). In multiple regression analysis, duration of CVPC, hs-CRP and TNF-α were predictors of serum NGAL in HD patients. Conclusion: The inflammation was observed in HD patients and increases with CVPC. Our findings show that a strong relationship between serum NGAL levels and inflammation markers. NGAL may be used as a new marker for inflammation in HD patients.
Effect of renal transplantation on endothelial function in haemodialysis patients
Background. Haemodialysis patients (HD) have been characterized by a high incidence and prevalence of atherosclerotic cardiovascular disease. Based on the traditional cardiovascular risk factors in this population, we cannot explain this high incidence and prevalence. One of the mechanisms contributing to cardiovascular risk in HD patients may be to uraemic toxins. Cardiovascular risk factors and uraemic toxins themselves may cause endothelial dysfunction, which may play a pivotal role in the development and progression of atherosclerosis in this population. We hypothesized that elimination of uraemic toxins in response to renal transplantation (RTx) can improve endothelial function as assessed by flow-mediated dilatation of brachial artery in haemodialysis (HD) patients. Methods. Endothelial function measured by flowmediated dilatation of the brachial artery (FMD) and glyceryltrinitrate-induced dilatation of the brachial artery (NMD) were assessed twice, during haemodialysis treatment and after RTx in 30 chronic haemodialysis patients. All patients were characterized by absence of known atherosclerotic disease and traditional cardiovascular risk factors. We also studied ageand gender-matched 20 normotensive healthy controls. Results. FMD values significantly improved after RTx (6.69±3.1% vs 10.50±3.0%, P<0.001) in HD patients. FMD of patients both during haemodialysis and after RTx was lower than in healthy controls (6.69±3.1%, 10.50±3.0% vs 14.02±2.3%, P<0.001 and P<0.01, respectively). There was no change in NMD values after RTx in HD patients (16.27±1.9% vs 16.30±1.8%, P>0.05). Also, NMD values in all patients were similar to healthy control values.
Nephrology Dialysis Transplantation, 2003
Background. Endothelial function of large arteries is impaired in chronic haemodialysis patients and oxidative stress due to the dialysis procedure has been suggested as a causal factor. However, it is not clear whether different types of dialysis membranes affect endothelial function differently. Therefore we determined endothelium-dependent, flow-mediated dilatation (FMD) of the brachial artery as well as markers of oxidative stress immediately before and after haemodialysis (HD) with either a cellulosic cuprophane or a synthetic polysulphone dialyser in a blinded, randomized, cross-over study. Methods. Twelve haemodialysis patients (age 55"3 years, time on dialysis 20"2 months, mean fluid change À1782"21 ml, systolicudiastolic blood pressure 139u75 mmHg) were included. Using a multi-gatepulsed Doppler system (echo-tracking device) brachial artery FMD and nitroglycerine-induced, endotheliumindependent vasodilatation (NMD) were measured. Patients were randomized to HD with either a polysulphone or a cuprophane membrane and were crossed over to the other filter. Investigators were blinded to the type of membrane used. Serum concentrations of oxidized LDL (oxLDL) and a-tocopherol as markers of oxidative stress were measured before and after each dialysis session.
Dialysis. Pathophysiology and Clinical Studies
Nephrology Dialysis Transplantation, 2014
Introduction and Aims: A high level of fibroblast growth factor 23 (FGF23) is a risk factor for mortality, and recent studies have linked FGF23 to parameters of volume homeostasis and an increased risk of heart failure. In hemodialysis (HD), a large ultrafiltration volume (UFV) is also associated with an increased mortality risk. We aimed to investigate whether circulating FGF23 levels and ultrafiltration volume are related in a cohort of stable HD patients. Methods: Post-hoc analysis on a prospective cohort study of 104 HD patients, median age 66 (interquartile range 51-75) years, dialysis vintage 25.0 (8.5-51.2) months, who underwent a standard four-hour HD session at the first session of the week. Blood samples were drawn at onset of HD. Plasma C-terminal FGF23 was determined by ELISA. Residual renal function (RRF) and Kt/V were extracted from patient records. We used uni-and multivariate linear regression to assess the association between UFV and FGF23. Natural log (Ln)-transformation was applied when appropriate. Results: At start of the HD session the median FGF23 level was 7535 [interquartile range 3276-13433] RU/mL. Mean UFV throughout the HD session was 2561 (standard deviation ±771) mL. In univariate analysis, natural log-transformed (Ln) FGF23 levels correlated with UFV (Figure 1), and also with serum phosphate (R=0.587, P<0.001), age (R=-0.384 P<0.001), and Ln Kt/V (R=-0.252 P=0.01), but not significantly with calcium (R=0.167 P=0.09). Multivariate linear regression analysis revealed a consistent strong association between Ln FGF23 AND UFV (St. β 0.385, P<0.001), in a model adjusted for serum phosphate (Standardized β 0.451, P<0.001) and serum calcium (St. β 0.222, P=0.002; model R2 52%). Age, gender, dialysis vintage, Kt/V, systolic and diastolic blood pressure did not contribute to this model. The association between FGF23 and UFV was independent of serum phosphate (Figures 1, 2). Patients with relevant residual renal function had a trend for lower FGF23 levels (Mann-Whitney P=0.04, Spearman's Rho-0.230 P=0.04), however RRF was no correlate of FGF23 in multivariate analysis (St. β-0.111, P=0.16).
The impact of dialysis type on biomarkers for cardiovascular diseases
coronary artery …, 2011
Diyaliz tipinin kardiyovasküler hastalık ciddiyetini yansıtan biyobelirteçler üzerindeki etkisi tam olarak bilinmemektedir. Bu çalışmada, son dönem böbrek hastalarında diyaliz tipinin kardiyovasküler hastalık belirteçleri üzerindeki etkisi araştırıldı. Çalışma planı: Çalışmaya, son dönem böbrek hastalığı nedeniyle en az üç aydır kronik diyaliz tedavisi görmekte olan 108 hasta alındı. Elli yedi hasta hemodiyaliz tedavisi görürken, 51 hastaya periton diyalizi uygulanıyordu. Kan örnekleri diyalizin hemen sonrasında toplandı. Serumda beyin natriüretik peptidi N-terminal prohormonu (NT-proBNP), yüksek duyarlıklı C-reaktif protein (hs-CRP), kardiyak tropinin I (TnI), interlökin-6 (IL-6), tümör nekroz faktörü-alfa (TNF-α) düzeyleri ve plazma fibrinojen düzeyleri ölçüldü ve iki diyaliz grubu arasında karşılaştırıldı. Bulgular: İki diyaliz grubu yaş ve cinsiyet açısından benzerdi. Periton diyalizi uygulanan hastalarda hipertansiyon sıklığı ve total kolesterol, HDL-kolesterol, LDLkolesterol ve hemoglobin düzeyleri anlamlı derecede daha yüksek idi. Serum NT-proBNP, hs-CRP, IL-6, TNF-α düzeyleri ve plazma fibrinojen düzeyi iki diyaliz grubu arasında anlamlı farklılık göstermedi; serum TnI düzeyi ise periton diyalizi grubunda anlamlı derecede daha yüksek bulundu (p= 0.04). Tüm hastalar diyaliz süresine (<12 ay, 12-36 ay ve >36 ay) göre gruplandırılarak karşılaştırıldığında, daha uzun diyaliz süresinde NT-proBNP, TNF-α ve hs-CRP düzeyleri anlamlı derecede daha düşük bulundu (p<0.05). Sonuç: Uygulanan diyaliz tipi serum NT-proBNP, hs-CRP, IL-6 ve TNF-α ve plazma fibrinojen düzeylerini etkilememekte, ancak TnI düzeyi periton diyalizi uygulanan hastalarda daha yüksek seyretmektedir. Objectives: The impact of dialysis type on the biomarkers that reflect the severity of cardiovascular diseases is not clearly known. We aimed to investigate the effect of dialysis type on biomarkers of cardiovascular diseases in patients with end-stage renal disease (ESRD). Study design: The study included 108 patients who had been on dialysis treatment (57 patients receiving hemodialysis, 51 patients receiving peritoneal dialysis) for ESRD for at least three months. Blood samples were collected just after the dialysis. Serum N-terminal prohormone of brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP), cardiac troponin I (TnI), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and plasma fibrinogen levels were measured and compared between the two dialysis groups. Results: The two dialysis groups were similar with respect to age and gender. The frequency of hypertension was significantly higher in patients receiving peritoneal dialysis. This group also had higher total cholesterol, HDL cholesterol, LDL cholesterol, and hemoglobin levels. Serum levels of NT-proBNP, hs-CRP, IL-6, and TNF-α, and plasma fibrinogen levels were similar in the two dialysis groups (p>0.05), but TnI was significantly higher in patients receiving peritoneal dialysis (p=0.04). Comparison of the patient subgroups based on the duration of dialysis (<12 months, 12-36 months, and >36 months) showed that longer dialysis duration was associated with significantly lower values of NT-proBNP, TNF-α, and hs-CRP (p<0.05). Conclusion: The dialysis type does not affect serum NT-proBNP, hs-CRP, IL-6, TNF-α, and plasma fibrinogen levels, but TnI level is higher in patients treated with peritoneal dialysis.