, Volume 18, Issue 6, pp 304-309
Date: 21 Aug 2009

Vascular Dysfunction in ESRD Patients Under Replacement Therapy

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Abstract

Endothelial dysfunction (ED) is an important factor in the pathogenesis of atherosclerosis, which is the major cause of mortality and morbidity in ESRD patients. Endothelium exerts a number of vasoprotective effects, such as vasodilatation, suppression of smooth muscle cell growth, and inhibition of inflammatory responses impairment of endothelial functions can leads to vascular dysfunction. This study involved 25 ESRD patients on regular hemodialysis (HD) (group 1), 15 ESRD patients on intermittent peritoneal dialysis (PD) (group 2) and 20 healthy control subjects (group 3). For all groups complete medical history and thorough examination, biochemical Laboratory tests including renal function tests, calcium, phosphorus, intact PTH and Echocardiography. Endothelial function was assessed by Flow mediated dilatation of the brachial artery (FMD) evaluated non-invasively by B-mode ultrasonography. Comparison of FMD of brachial artery shows significant difference between hemodialysis group and control (p < 0.001), peritoneal dialysis group and control group (p < 0.001), and between hemodialysis and peritoneal dialysis group (p < 0.001). Multiple regression test for brachial artery flow mediated dilatation shows significant correlations with age (p < 0001), serum LDL (p = 0.04), hematocrit value (p < 0.001), serum PTH (P = 0.01) and presence of DM (p = 0.009). No correlation is found with duration of dialysis (p = 0.57), total cholesterol (p = 0.62), serum triglyceride (p = 0.10) nor with calcium phosphorus products (p = 0.08). Endothelial function is impaired in ESRD patients. PD patients had more endothelial dysfunction when compared to HD patients. ED is independently affected by age, LDL, PTH, hematocrit and presence of diabetes mellitus. The main correctable factors affecting ED are Hematocrit, PTH, and LDL.