Arterial stiffness and functional properties in chronic kidney disease patients on different dialysis modalities: an exploratory study

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2010-12, Vol.25 (12), p.4031-4041
• Main Authors: Chung, Ada W. Y., Yang, H. H. Clarice, Kim, Jong Moo, Sigrist, Mhairi K., Brin, Genevieve, Chum, Elliott, Gourlay, William A., Levin, Adeera
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Flow Velocity - physiology; Chronic Disease; chronic kidney disease; Elasticity - physiology; Emergency and intensive care: renal failure. Dialysis management; Epigastric Arteries - physiopathology; Female; haemodialysis; Humans; Intensive care medicine; Kidney Diseases - physiopathology; Kidney Diseases - surgery; Kidney Diseases - therapy; Kidney Transplantation; Male; Medical sciences; Middle Aged; oxidative stress; Oxidative Stress - physiology; peritoneal dialysis; Peritoneal Dialysis - methods; Renal Dialysis - methods; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Vasoconstriction - physiology; vasomotor function; Vasomotor System - physiology
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfq202

Background. Abnormalities of vascular function and accumulation of oxidative stress have been associated with chronic kidney disease (CKD). Dialysis modalities, peritoneal dialysis (PD) and haemodialysis (HD) may differentially impact on vascular function and oxidative stress. Methods. Patients undergoing living donor transplantation were studied for vascular stiffness using pulse wave velocity measurements, and inferior epigastric arteries were harvested to examine in vitro stiffness and functional properties and evidence of oxidative stress. Forty-one patients were studied representing PD (n = 12), HD (n = 14) and non-dialysed recipients (n = 15). Results. We demonstrated differences in stiffness from in vivo and in vitro measurements such that non-dialysis < HD < PD groups. The stiffness measurements did not correlate with duration of CKD nor dialysis duration, but did so with phosphate levels (r = 0.356, P = 0.02). From the in vitro isometric force experiments, HD arteries demonstrated decreased contractility and endothelium-dependent relaxation compared with PD and non-dialysis vessels. Level of oxidative stress (as indicated by the 8-isoprostane level) was 30% higher in HD arteries than in PD arteries. Protein expression of inducible nitric oxide synthase, NADPH subunits and xanthine oxidase was upregulated in HD arteries, while superoxide dismutase was downregulated. The compromised vascular function in HD arteries was improved by pharmacological means that eliminated oxidative stress. Conclusions. We report associations between vasomotor function and oxidative stress in the vasculature of patients receiving different dialysis therapies. Oxidative stress, which may be differentially augmented during PD and HD, may play an important role in the vascular dysfunction in dialysis populations.