Brachial artery was imaged during reactive hyperemia (endothelium-dependent, flow-mediated dilatation, FMD) and during glyceryl trinitrate-mediated dilatation (nitroglycerine-mediated dilatation, NMD, endothelium-independent) in 108 patients with CKD and three months following renal transplantation (RT) in 60 of them.

Results

Patients with CKD had significantly lower FMD vs. controls (9.1% vs. 18.3%, p < 0.001) while NMD was comparable (19.8% vs. 21.8%, p = ns). Impaired FMD (<4.5%) was observed in 26.8% patients with CKD and was more common in those on hemodialysis (HD; 28.4% vs. 15.4%) vs. those not on dialysis. FMD for patients with glomerular filtration rate (GFR) 15–60 vs. <15 mL/min/1.73 m² was 12.9% and 8.8% (p = 0.05; respectively −29% and −52% lower vs. controls), indicating reduced FMD with increasing CKD severity. There was +72% increase in FMD following RT (9.1 to 15.7%, p < 0.001) while mean NMD was unchanged. Following RT, only 3.3% had impaired FMD.

Conclusions

Patients with CKD have endothelial dysfunction as evidenced by reduced FMD. Decreased FMD indicating worsening endothelial function was noted with increasing severity of CKD. Within three months of RT, there was significant improvement in FMD, while NMD values did not change.

References

1Anavekar NS, McMurray JJV, Velazquez EJ et al. Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med 2004: 351: 1285.
10.1056/NEJMoa041365
CAS PubMed Web of Science® Google Scholar
2 National Institutes of Health. National Institute of Diabetes and Digestive and Kidney Diseases. U.S. Renal Data System, USRDS 1996 Annual Data Report. Bethesda.
Google Scholar
3Davignon J, Ganz P. Role of endothelial dysfunction in atherosclerosis. Circulation 2004: 109: 27.
10.1161/01.CIR.0000131515.03336.f8
CAS Web of Science® Google Scholar
4Félétou M, Vanhoutte PM. “Endothelial dysfunction a multifaceted disorder.” Am J Physiol 2006: 291: 985H.
10.1152/ajpheart.00292.2006
CAS PubMed Web of Science® Google Scholar
5Perticone F, Maio R, Perticone M et al. “Endothelial dysfunction and subsequent decline in glomerular filtration rate in hypertensive patients.” Circulation 2010: 122: 379.
10.1161/CIRCULATIONAHA.110.940932
CAS PubMed Web of Science® Google Scholar
6Wever R, Boer P, Hijmering M et al. Nitric oxide production is reduced in patients with chronic renal failure. Arterioscler Thromb Vasc Biol 1999: 19: 1168.
10.1161/01.ATV.19.5.1168
CAS PubMed Web of Science® Google Scholar
7Passauer J, Pistrosch F, Bussemaker E, Lassig G, Herbrig K, Gross P. Reduced agonist-induced endothelium-dependent vasodilation in uremia is attributable to an impairment of vascular nitric oxide. J Am Soc Nephrol 2005: 16: 959.
10.1681/ASN.2004070582
CAS PubMed Web of Science® Google Scholar
8Martens CR, Edwards DG. Peripheral vascular dysfunction in chronic kidney disease. Cardiol Res Pract 2011: 51: 257.
Google Scholar
9Schmidt RJ, Baylis C. Total nitric oxide production is low in patients with chronic renal disease. Kidney Int 2000: 58: 1261.
10.1046/j.1523-1755.2000.00281.x
CAS PubMed Web of Science® Google Scholar
10Boger RH. Asymmetric dimethyl arginine, an endogenous inhibitor of nitric oxide synthase, explains the L-arginine paradox and acts as a novel cardiovascular risk factor. J Nutr 2004: 134(10 Suppl): 2842.
PubMed Web of Science® Google Scholar
11Vallence P, Leone A, Calver A, Collier J, Moncada S. Accumulation of an endogenous inhibitor of nitric oxide synthesis in chronic renal failure. Lancet 1992: 339: 572.
Google Scholar
12Stam F, van Guldener C, Becker A et al. Endothelial dysfunction contributes to renal function-associated cardiovascular mortality in a population with mild renal insufficiency: the Hoorn study. J Am Soc Nephrol 2006: 17: 537.
10.1681/ASN.2005080834
CAS PubMed Web of Science® Google Scholar
13Celermajer DS, Sorensen KE, Gooch VM, Spiegelhalter DJ, Miller OI. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet 1992: 340: 1111.
10.1016/0140-6736(92)93147-F
CAS PubMed Web of Science® Google Scholar
14Corretti MC, Anderson TJ, Benjamin EJ et al. Guidelines for the ultrasound assessment of endothelial-dependent flow mediated vasodilation of the brachial artery: a report of the International Brachial Artery Reactivity Task Force. J Am Coll Cardiol 2002: 39: 257.
10.1016/S0735-1097(01)01746-6
PubMed Web of Science® Google Scholar
15Neunteufl T, Katzenschlager R, Hassan A et al. Systemic endothelial dysfunction is related to the extent and severity of coronary artery disease. Atherosclerosis 1997: 129: 111.
10.1016/S0021-9150(96)06018-2
CAS PubMed Web of Science® Google Scholar
16Chan SY, Mancini GBJ, Kuramoto L et al. The prognostic importance of endothelial dysfunction and carotid atheroma burden in patients with coronary artery disease. J Am Coll Cardiol 2003: 42: 1037.
10.1016/S0735-1097(03)00927-6
CAS PubMed Web of Science® Google Scholar
17Modena MG, Bonetti L, Coppi F, Bursi F, Rossi R. Prognostic role of reversible endothelial dysfunction in hypertensive postmenopausal women. J Am Coll Cardiol 2002: 40: 505.
10.1016/S0735-1097(02)01976-9
PubMed Web of Science® Google Scholar
18Kuczmarski JM, Darocki MD, DuPont JJ et al. Effect of moderate-to-severe chronic kidney disease on flow-mediated dilation and progenitor cells. Exp Biol Med (Maywood) 2011: 236: 1085.
10.1258/ebm.2011.011008
CAS PubMed Web of Science® Google Scholar
19Poulikakos D, Ross L, Recio-Mayoral A et al. Left ventricular hypertrophy and endothelial dysfunction in chronic kidney disease. Eur Heart J Cardiovasc Imaging 2014: 15: 56.
10.1093/ehjci/jet120
Web of Science® Google Scholar
20Thambyrajah J, Landray MJ, McGlynn FJ, Jones HJ, Wheeler DC, Townend JN. Abnormalities of endothelial function in patients with predialysis renal failure. Heart 2000: 83: 205.
10.1136/heart.83.2.205
CAS PubMed Web of Science® Google Scholar
21Prasad N, Kumar S, Singh A et al. Carotid intimal thickness and flow-mediated dilatation in diabetic and nondiabetic continuous ambulatory peritoneal dialysis patients. Perit Dial Int 2009: 29(S2): S96.
CAS Google Scholar
22Recio-Mayoral A, Banerjee D, Streather C, Kaski JC. Endothelial dysfunction, inflammation and atherosclerosis in chronic kidney disease–a cross-sectional study of predialysis, dialysis and kidney-transplantation patients. Atherosclerosis 2011: 216: 446.
10.1016/j.atherosclerosis.2011.02.017
CAS PubMed Web of Science® Google Scholar
23Reffelmann T, Krebs A, Ittermann T et al. Mild renal dysfunction as a non-traditional cardiovascular risk factor?—association of cystatin C-based glomerular filtration rate with flow-mediated vasodilation. Atherosclerosis 2010: 211: 660.
10.1016/j.atherosclerosis.2010.03.023
CAS Web of Science® Google Scholar
24Nerpin E, Ingelsson E, Risérus U et al. Association between glomerular filtration rate and endothelial function in an elderly community cohort. Atherosclerosis 2012: 224: 242.
10.1016/j.atherosclerosis.2012.07.008
CAS PubMed Web of Science® Google Scholar
25Foster MC, Keyes MJ, Larson MG et al. Relations of measures of endothelial function and kidney disease: the Framingham Heart Study. Am J Kidney Dis 2008: 52: 859.
10.1053/j.ajkd.2008.04.027
PubMed Web of Science® Google Scholar
26Peralta CA, Jacobs DR Jr, Katz R et al. Association of pulse pressure, arterial elasticity, and endothelial function with kidney function decline among adults with estimated GFR > 60 mL/min/1.73 m2: the multi-ethnic study of atherosclerosis. Am J Kidney Dis 2012: 59: 41.
10.1053/j.ajkd.2011.08.015
PubMed Web of Science® Google Scholar
27Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999: 130: 461.
10.7326/0003-4819-130-6-199903160-00002
CAS PubMed Web of Science® Google Scholar
28Schroeder S, Enderle MD, Ossen R et al. Noninvasive determination of endothelium-mediated vasodilation as a screening test for coronary artery disease: pilot study to assess the predictive value in comparison with angina pectoris, exercise electrocardiography, and myocardial perfusion imaging. Am Heart J 1999: 138: 731.
10.1016/S0002-8703(99)70189-4
CAS PubMed Web of Science® Google Scholar
29Cross JM, Donald A, Patrick J, Deanfield JE, Woolfson RG, MacAllister RJ. Dialysis improves endothelial function in humans. Nephrol Dial Transplant 2001: 16: 1823.
10.1093/ndt/16.9.1823
CAS PubMed Web of Science® Google Scholar
30Yilmaz MI, Sonmez A, Saglam M et al. Longitudinal analysis of vascular function and biomarkers of metabolic bone disorders before and after renal transplantation. Am J Nephrol 2013: 37: 126.
10.1159/000346711
CAS Web of Science® Google Scholar
31Yilmaz MI, Sonmez A, Qureshi AR et al. Endogenous testosterone, endothelial dysfunction, and cardiovascular events in men with nondialysis chronic kidney disease. Clin J Am Soc Nephrol 2011: 6: 1617.
10.2215/CJN.10681210
CAS PubMed Web of Science® Google Scholar
32Kari JA, Donald AE, Vallance DT et al. Physiology and biochemistry of endothelial function in children with chronic renal failure. Kidney Int 1997: 52: 468.
10.1038/ki.1997.354
PubMed Web of Science® Google Scholar
33Passauer J, Bussemaker E, Lassig G, Gross P. Kidney transplantation improves endothelium-dependent vasodilation in patients with end-stage renal disease. Transplantation 2003: 75: 1907.
10.1097/01.TP.0000065739.19681.93
PubMed Web of Science® Google Scholar
34Covic A, Goldsmith DJ, Gusbeth-Tatomir P, Buhaescu I, Covic M. Successful renal transplantation decreases aortic stiffness and increases vascular reactivity in dialysis patients. Transplantation 2003: 76: 1573.
10.1097/01.TP.0000086343.32903.A8
CAS PubMed Web of Science® Google Scholar
35Kocak H, Ceken K, Yavuz A et al. Effect of renal transplantation on endothelial function in haemodialysis patients. Nephrol Dial Transplant 2006: 21: 203.
10.1093/ndt/gfi119
PubMed Web of Science® Google Scholar
36Oflaz H, Turkmen A, Turgut F et al. Changes in endothelial function before and after renal transplantation. Transpl Int 2006: 19: 333.
10.1111/j.1432-2277.2006.00288.x
CAS PubMed Web of Science® Google Scholar
37Al Mheid I, Patel R, Murrow J et al. Vitamin D status is associated with arterial stiffness and vascular dysfunction in healthy humans. J Am Coll Cardiol 2011: 58: 186.
10.1016/j.jacc.2011.02.051
CAS PubMed Web of Science® Google Scholar
38Li YC, Kong J, Wei M, Chen ZF, Liu SQ, Cao LP. 1,25-dihydroxyvitamin D(3) is a negative endocrine regulator of the renin-angiotensin system. J Clin Invest 2002: 110: 229.
10.1172/JCI0215219
CAS PubMed Web of Science® Google Scholar
39Kuzmenko AI, Morozova RP, Nikolenko IA, Korniets GV, Kholodova YuD. Effects of vitamin D3 and ecdysterone on free-radical lipid peroxidation. Biochemistry (Mosc) 1997: 62: 609.
CAS PubMed Web of Science® Google Scholar
40Hausberg M, Kisters K, Kosch M, Rahn KH, Barenbrock M. Flow-mediated vasodilation and distensibility of the brachial artery in renal allograft recipients. Kidney Int 1999: 55: 1104.
10.1046/j.1523-1755.1999.0550031104.x
PubMed Web of Science® Google Scholar
41Kosch M, Hausberg M, Suwelack B. Studies on effects of calcineurin inhibitor withdrawal on arterial distensibility and endothelial function in renal transplant recipients. Transplantation 2003: 76: 1516.
10.1097/01.TP.0000092521.57633.BD
PubMed Web of Science® Google Scholar
42Imai E, Horio M, Nitta K et al. Estimation of glomerular filtration rate by the MDRD study equation modified for Japanese patients with chronic kidney disease. Clin Exp Nephrol 2007: 11: 41.
10.1007/s10157-006-0453-4
PubMed Google Scholar
43Srinivas S, Annigeri RA, Mani MK, Rao BS, Kowdle PC, Seshadri R. Estimation of glomerular filtration rate in South Asian healthy adult kidney donors. Nephrology (Carlton) 2008: 13: 440.
10.1111/j.1440-1797.2008.00967.x
CAS PubMed Web of Science® Google Scholar
44Teo BW, Xu H, Wang D et al. GFR estimating equations in a multiethnic Asian population. Am J Kidney Dis 2011: 58: 56.
10.1053/j.ajkd.2011.02.393
PubMed Web of Science® Google Scholar

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Volume28, Issue8

August 2014

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Assessment of endothelial dysfunction in Asian Indian patients with chronic kidney disease and changes following renal transplantation

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Assessment of endothelial dysfunction in Asian Indian patients with chronic kidney disease and changes following renal transplantation

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