Arterial hypertension, cardiovascular remodeling and plasma level of osteopontin in patients with end-stage kidney disease on hemodialysis

Abstract

Large population-based studies acknowledge that patients with chronic kidney disease (CKD) have high risk of cardiovascular (CV) diseases regardless of etiology, especially in its late stages. Deceleration of glomerular fi ltration on every 10 mL/min increases cardiovascular risk and risk of death from any causes up to 20 %, that reaches the maximum level in patients on renal replacement therapy [2,11]. Lesion of cardiovascular system in subjects suffering from CKD occurs in different pathogenic mechanisms simultaneously. One of the main factors of development the CV remodeling in dialysis patients is arterial hypertension (AH). It occurs as a result of volume overload, anemia and existing arteriovenous fi stula [3]. Further the number of investigators pay a special attention to bone mineral violations in the development of the CV remodeling, specifi cally to high level of phosphate and vascular calcifi cation (VC) [5,18]. The extracellular phosphate mechanism of action is induction of the osteoblastic differentiation factors. One of this factors is osteopontin (OP) [10]. As pleotropic cytokine this major noncollagenous bone matrix protein is expressed in mineralized tissue and synthesized by fi broblasts, osteoblasts, smooth muscle and endothelial cells [6,23]. OP regulation is not completely investigated yet. But there are results of the protein activity stimulation due to activity of proinfl ammatory cytokines, angiotensin II [12]. Literature data indicate the expression of OP in hypertrophied myocardium [1]. This cytokine is believed to cause smooth muscle cells proliferation and elastic membrane degradation, thus to trigger processes of vascular remodeling. The negative role of OP in the development of diastolic dysfunction in patients Aim. Large population-based studies acknowledge that patients with chronic kidney disease have a high risk of cardiovascular diseases regardless of etiology, especially in its late stages. The aim of this study was to investigate the features of arterial hypertension, cardiovascular remodeling and plasma level of osteopontin in dynamics of candesartan therapy, as well as to identify the relationships between studied parameters in patients with chronic kidney disease treated by hemodialysis.Methods and results. 50 patients were performed ambulatory blood pressure monitoring, the plasma level of osteopontin was determined by ELISA method, standard echocardiography and ultrasonography of common carotid after treatment of candesartan during 12 weeks.Conclusion. The results indicate that the use of candesartan cilexetil in hemodialysis populations promotes regression of left ventricular hypertrophy and vascular remodeling indices, has antihypertensive effect.Артеріальна гіпертензія, кардіоваскулярне ремоделювання та плазмовий рівень остеопонтину в пацієнтів із кінцевою стадією хронічної хвороби нирок на гемодіалізі В. А. Візір, О. Г. Овська, А.С. СадомовМасштабні популяційні дослідження свідчать, що пацієнти з термінальною нирковою недостатністю мають високий ризик розвитку серцев...