Endothelial Dysfunction Is Associated With Major Adverse Cardiovascular Events in Peritoneal Dialysis Patients

Lee, Mi Jung; Han, Seung Hyeok; Lee, Jung Eun; Yoon, Chang Yun; Kim, Eun Jin; Han, Jae Hyun; Han, Ji Suk; Oh, Hyung Jung; Park, Sun-Hee; Kang, Shin Wook; Yoo, Tae Hyun

doi:10.1097/md.0000000000000073

Cited by 24 publications

(25 citation statements)

References 49 publications

(78 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Among patients with CKD, endothelial dysfunction is common (2, 3) and predicts adverse outcomes. (4, 5) A prior study did not find an association between endothelial dysfunction and cardiac mechanics in patients with ESRD, (6) but we hypothesized that such an association could be found with more sensitive measures of cardiovascular dysfunction and consistent timing of cardiovascular measurements with respect to dialysis. The C ardiac, E ndothelial Function and A r terial Stiffness in ES RD (CERES) study is an ongoing, prospective observational study designed to provide in-depth measures of vascular and cardiac function and determine the utility of these measures in predicting heart failure and overall mortality in ESRD.…”

Section: Introductionmentioning

confidence: 88%

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

et al. 2016

View full text Add to dashboard Cite

Patients with end-stage renal disease (ESRD) suffer high rates of heart failure and cardiovascular mortality, and we lack a thorough understanding of what, if any, modifiable factors contribute to cardiac dysfunction in these high-risk patients. In order to evaluate endothelial function as a potentially modifiable cause of cardiac dysfunction in ESRD, we investigated cross-sectional associations of macro- and microvascular dysfunction with left and right ventricular dysfunction in a well-controlled ESRD cohort. We performed comprehensive echocardiography, including tissue Doppler imaging and speckle tracking echocardiography of the left and right ventricle, in 149 ESRD patients enrolled in an ongoing prospective, observational study. Of these participants, 123 also underwent endothelium-dependent flow-mediated dilation (FMD) of the brachial artery (macrovascular function). Microvascular function was measured as the velocity time integral (VTI) of hyperemic blood flow following cuff deflation. Impaired FMD was associated with higher LV mass, independently of age and blood pressure: per two-fold lower FMD, LV mass was 4.1% higher (95%CI [0.49, 7.7], p=0.03). After adjustment for demographics, blood pressure, comorbidities and medications, a two-fold lower VTI was associated with 9.5% higher E/e’ ratio (95% CI [1.0, 16], p=0.03) and 6.7% lower absolute RV longitudinal strain (95% CI [2.0, 12], p=0.003). Endothelial dysfunction is a major correlate of cardiac dysfunction in ESRD, particularly diastolic and right ventricular dysfunction, in patients whose volume status is well-controlled. Future investigations are needed to determine whether therapies targeting the vascular endothelium could improve cardiac outcomes in ESRD.

show abstract

Section: Introductionmentioning

confidence: 88%

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

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Due to the negative impacts of uremia and oxidative stress on the endothelial cells, flow-mediated, endothelium-dependent vasodilation is markedly reduced in uremic patients compared with normal control patients [162, 163]. The reasons for this endothelial dysfunction include increased oxidative stress, the presence of NO inhibitors such as asymmetric dimethylargine (AMDA) and a reduced number and function of endothelial progenitor cells [164].…”

Section: Mechanisms Contributing To Avf Maturation and Failurementioning

confidence: 99%

Future research directions to improve fistula maturation and reduce access failure

Patel

Hänisch

et al. 2016

Seminars in Vascular Surgery

View full text Add to dashboard Cite

With the increasing prevalence of end stage renal disease there is a growing need for hemodialysis. Arteriovenous fistulae (AVF) are the preferred type of vascular access for hemodialysis but maturation and failure continue to present significant barriers to successful fistula use. AVF maturation integrates outward remodeling with vessel wall thickening in response to drastic hemodynamic changes, in the setting of uremia, systemic inflammation, oxidative stress and preexistent vascular pathology. AVF can fail due to both failure to mature adequately to support hemodialysis, as well as development of neointimal hyperplasia (NIH) that narrows the AVF lumen, typically near the fistula anastomosis. Failure due to NIH involves vascular cell activation and migration and extracellular matrix remodeling with complex interactions of growth factors, adhesion molecules, inflammatory mediators, and chemokines, all of which result in maladaptive remodeling. Different strategies have been proposed to prevent and treat AVF failure, based on current understanding of the modes and pathology of access failure; these approaches range from appropriate patient selection and use of alternative surgical strategies for fistula creation, to the use of novel interventional techniques or drugs to treat failing fistulae. Effective treatments to prevent or treat AVF failure requires a multidisciplinary approach involving nephrologists, vascular surgeons and interventional radiologists, allowing careful patient selection and the use of tailored systemic or localized interventions to improve patient-specific outcomes. This review provides contemporary information on the underlying mechanisms of AVF maturation and failure and discusses the broad spectrum of options that can be tailored for specific therapy.

show abstract

“…Although there are few studies on the relationship between endothelial dysfunction and atherosclerotic process in PD patients (14), there is no study evaluating the effect on mortality of ADMA levels and FMD, and the relationship between these two parameters in PD patients who have increased risk for cardiovascular complications. We have previously studied the relationship between ADMA levels and cardiac functions in PD patients (15).…”

Section: Introductionmentioning

confidence: 99%

Flow-Mediated Dilatation and Asymmetric Dimethylarginine Do Not Predict Mortality in Peritoneal Dialysis Patients

Uzun¹,

Karadağ²,

Gürsu³

et al. 2017

Haseki

View full text Add to dashboard Cite

Akım Aracılı Dilatasyon ve Asimetrik Dimetilargi Periton Diyalizi Hastalarında Mortalite Prediktörü DeğildirAim: Asymmetric dimethylarginine (ADMA) is associated with increased coronary artery disease risk through endothelial dysfunction in dialysis patients. We aimed to investigate the role of flow-mediated dilatation (FMD), a non-invasive indicator of endothelial function, and ADMA in mortality in peritoneal dialysis (PD) patients.Methods: PD patients aged 18-80 years; with dialysis duration of at least three months were included. FMD measurement and ADMA levels were recorded. Outcome of the patients on the third year were analyzed with binary logistic analyses. Results:The mean age of the 55 patients was 53±15 years and the mean follow-up duration was 36 months. Mean FMD and ADMA levels were 10.6±6.4% and 81.8±48.0 mol/L, respectively. Eighteen patients died during follow-up. Age, presence of diabetes mellitus and ischemic heart disease, ultrafiltration amount and serum albumin level were related with mortality while gender, weekly Kt/V and ADMA levels were not. There was no significant relationship between ADMA level and FMD (p=0.873). FMD was negatively correlated with systolic and diastolic blood pressures (p=0.001, p<0.001, respectively). Hypertension was found to be the most important single factor determining FMD (p=0.037). Conclusion:Estimating endothelial function by FMD or measuring serum ADMA levels may not be useful for predicting mortality in PD patients.Keywords: Flow mediated dilatation, asymmetric dimethylarginine, endothelial dysfunction, peritoneal dialysis, mortality Amaç: Diyaliz hastalarında asimetrik dimetilarginin (ADMA) endotel disfonksiyonu yoluyla artmış koroner arter hastalığı riski ile ilişkilidir. Bu çalışmada periton diyalizi (PD) hastalarında endotel disfonksiyonunun non-invaziv bir göstergesi olan akım aracılı dilatasyon (AAD) ve ADMA'nın mortalite ile ilişkisini araştırmayı amaçladık.Yöntemler: Çalışmaya 18-80 yaş aralığında, en az üç aydır diyaliz uygulanan PD hastaları dahil edildi. AAD ölçümü ve ADMA düzeyleri kaydedildi. Üçüncü yılda hasta sonlanımlarında "binary lojistik analizi" kullanıldı.Bulgular: Çalışmaya dahil edilen 55 hastanın yaş ortalaması 53±15 yıl, ortalama takip süresi 36 ay idi. Ortalama AAD ve ADMA düzeyleri sırasıyla %10,6±6,4 ve 81,8±48,0 mol/L idi. On sekiz hasta takip sırasında öldü. Yaş, diyabet ve iskemik kalp hastalığı varlığı, ultrafiltrasyon miktarı ve serum albümin düzeyleri mortalite ile ilişkili iken cinsiyet, haftalık Kt/V ve ADMA düzeyleri ilişkili değildi. ADMA düzeyleri ve AAD arasında anlamlı ilişki yoktu (p=0,873). AAD ile klinik parametrelerden sistolik ve diastolik kan basıncı arasında anlamlı negatif korelasyon vardı (p=0,001, p<0,001). Tüm parametreler arasında AAD'yi belirleyen en önemli tek faktör hipertansiyondu (p=0,037).Sonuç: AAD ile endotel fonksiyonunun değerlendirilmesi veya serum ADMA düzeylerinin ölçülmesi periton diyalizi hastalarında mortaliteyi tahmin etmek için yararlı olmayabilir.

show abstract

Endothelial Dysfunction Is Associated With Major Adverse Cardiovascular Events in Peritoneal Dialysis Patients

Cited by 24 publications

References 49 publications

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

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

Future research directions to improve fistula maturation and reduce access failure

Flow-Mediated Dilatation and Asymmetric Dimethylarginine Do Not Predict Mortality in Peritoneal Dialysis Patients

Contact Info

Product

Resources

About