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

作者：Sharma Jugal; Kapoor Aditya^*; Muthu Ranjanee; Prasad Narayan; Sinha Archana; Khanna Roopali; Kumar Sudeep; Garg Naveen; Tewari Satyendra; Sharma Raj K; Goel Pravin

来源：Clinical Transplantation, 2014, 28(8): 889-896.

DOI：10.1111/ctr.12398

• chronic kidney disease
• endothelial dysfunction
• flow-mediated dilation
• renal transplantation

Background Endothelial dysfunction may explain increased cardiovascular risk in patients with chronic kidney disease (CKD). Methods 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 threemonths 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. <15mL/min/1.73m2 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 threemonths of RT, there was significant improvement in FMD, while NMD values did not change.

• 出版日期2014-8