Flow-Mediated Vasodilation in End-Stage Renal Disease

Abstract

SummaryBackground and objectives An intact endothelium is essential for adaptations between arterial vasomotor tone and shear stress (SS), i.e., flow-mediated vasodilation (FMD). Endothelial dysfunction occurs in hypertension, cardiac insufficiency, diabetes, atherosclerosis, and in end-stage renal disease (ESRD) patients, whose renal failure is associated with many of those cardiovascular diseases (CVD).Design, setting, participants, & measurements Using a progressive hand-warming protocol and repeated measures ANOVA, we analyzed SS-mediated increase of brachial artery diameter (⌬BA) in 22 healthy controls, 18 CVD-negative ESRD patients (ESRD-CVD Ϫ ), and 17 CVD-positive ESRD patients (ESRD-CVD ϩ ) to analyze the role of uremia versus CVD on FMD.Results Hand-warming increased SS (P Ͻ 0.001) and ⌬BA (P Ͻ 0.001). Negative interactions were observed between ⌬BA and ESRD (P Ͻ 0.001), and between ⌬BA and CVD ؉ (P Ͻ 0.02), but there was no interaction between ESRD and CVD ϩ (P ϭ 0.69). For low and mild SS increases, ESRD-CVD Ϫ patients were characterized by similar ⌬BA as controls, but it was lower than controls at higher SS (P Ͻ 0.01). In ESRD-CVD ϩ patients, brachial artery diameter did not respond to mild and moderate SS increases, and showed "paradoxical" vasoconstriction at higher SS (P Ͻ 0.05). In ESRD, a positive and independent interaction was observed between ⌬BA and 25(OH) vitamin D 3 insufficiency (Յ15 g/L; P Ͻ 0.02). ConclusionsThese observations indicate that, independently of each other, ESRD and CVD ϩ history are associated with endothelial dysfunction. They also suggest the importance of considering the relationships between SS and endothelial function in different clinical conditions.

An overview of AVF maturation and endothelial dysfunction in an advanced renal failure

“…CRP C-reactive protein, IL-6 interleukin-6, NO nitric oxide, PAI-1 plasminogen activator inhibitor 1, PGI2 prostacyclin, sICAM soluble intercellular adhesion molecule, sVCAM soluble vascular cell adhesion molecule, TNF-α tumour necrosis factor alpha, vWF von Willebrand factor function in this CKD cohort is similar to what others have shown using both venous occlusion plethysmography techniques [43], and FMD [44]. Owens et al [45] determined FMD among 25 CKD patients prior to AVF creation and found very similar values (5.8 ± 1.0%).…”

Associations of Macro- and Microvascular Endothelial Dysfunction With Subclinical Ventricular Dysfunction in End-Stage Renal Disease

“…As others have elegantly described, endothelial dysfunction and inflammation are likely synergistic precursors to diastolic dysfunction. (28, 29) CKD exemplifies a disease state of endothelial dysfunction (30) and inflammation (31) and thus CKD may be an especially appropriate population to study associations between endothelial dysfunction, inflammation, and abnormal systolic and diastolic cardiac mechanics. Further studies of inflammatory mediators in these patients might clarify the role of inflammation in the associations that we observed.…”

Aliskiren, a Direct Renin Inhibitor, Improves Vascular Endothelial Function in Patients on Hemodialysis Independent of Antihypertensive Effect ∼ a Pilot Study∼

“…FMD of the brachial artery was assessed noninvasively using high-resolution ultrasound as described previously in detail [17,18,19]. For patients on hemodialysis, measurements were obtained before the first hemodialysis of the week.…”

“…An enzyme-linked immunosorbent assay (ELISA) kit for the detection of PDMPs [17,18,19] was obtained from JIMRO Co. Ltd. (Tokyo, Japan) as described previously in detail [20,21]. Briefly, a blood sample was collected from an arteriovenous fistula into a vacutainer containing ethylenediaminetetraacetic acid-acid citrate dextrose solution (EDTA-ACD; Nipro Co. Ltd., Japan).…”