Effects of whole blood viscosity and plasma NOx on cardiac function and cerebral blood flow in children with chronic kidney disease

Abstract

IntroductionWhole blood viscosity (WBV) is increasingly recognized as a factor implicated in the genesis of atherosclerosis and the progression of vascular disease, such as chronic kidney disease (CKD), in high-risk patients. The principal determinants of WBV are hematocrit, red blood cell deformability, and the viscosity of plasma. Changes in whole blood viscoelasticity are associated with cardiovascular and cerebrovascular complications among patients with CKD, especially in the fifth stage (1-3). Mechanical interaction between blood and vessels mediated by WBV has a crucial role in the release of endothelium-derived mediators such as NOx and endothelin, and subsequent vascular remodeling (1,4).The aim of the study was to investigate the effects of WBV and plasma NOx values on cerebral and cardiovascular risks associated with CKD and to compare the impact of hemodialysis (HD) and peritoneal dialysis (PD) treatments on WBV and plasma NOx levels in patients with CKD. Materials and methodsA cross-sectional study was performed in patients who were admitted to our pediatric nephrology department. The study fulfilled the requirements of good clinical practice according to the Declaration of Helsinki, and was approved by our local ethics committee (Date: 13.04.2011, Number: 66). Patients and their families were informed, and all subjects gave written informed consent prior to enrollment.Background/aim: The aim of the study was to investigate the effects of whole blood viscosity and plasma nitric oxide on cerebral and cardiovascular risks associated with chronic kidney disease. Materials and methods:The study group consisted of 40 pediatric patients and 21 healthy control subjects. Hematologic and biochemical variables, viscosity and plasma nitric oxide levels, echocardiographic findings, and middle cerebral artery blood flow velocity were examined.Results: Viscosity values of patients were significantly lower than those of the control group. Lower values of hematocrit, total protein, and albumin and higher values of ferritin in all patient groups resulted in significantly low viscosity levels. Plasma nitric oxide levels were higher in all patient groups than those in the controls. No statistically significant difference was present in middle cerebral artery blood flow velocity between the patient and control groups. Even when systolic functions were normal, the patient group had significant deterioration in diastolic functions, suggesting morbidity and mortality risks. Conclusions:Cerebral blood flow velocities were not affected by viscosity and nitric oxide levels, suggesting that cerebral circulation has the ability to make adaptive modulation. The metabolism of nitric oxide levels needs further investigation and studies in patients with chronic renal disease.

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