Increased cardiovascular risk factors and features of endothelial activation and dysfunction in dialyzed uremic patients.
Due to the incidence of symptomatic atherosclerosis in uremic patients, hemostasis-derived cardiovascular risk factors, basal plasma concentrations of some endothelial-derived glycoproteins and desmopressin-induced variations of endothelial-derived proteins were studied in 22 uremic patients on prolonged maintenance hemodialysis with no cardiovascular antecedent. Compared to control subjects, patients had increased predialysis hemostasis-related cardiovascular risk factors: high fibrinogen, proconvertin, and type 1 plasminogen activator inhibitor plasma concentrations; low albumin values; generally low antithrombin III values but sometimes high. They had high predialysis plasma concentrations of endothelium-derived glycoproteins: von Willebrand factor, tissue-type plasminogen activator and urokinase-type plasminogen activator, which are secreted by endothelial cells, but also soluble thrombomodulin, a marker of endothelial cell injury. The desmopressin-induced release of tissue-type plasminogen activator and of von Willebrand factor were lower than in controls. High fibrinogen, type 1 plasminogen activator inhibitor and low albumin plasma concentrations may be linked to repeated acute phase reactions associated with hemodialysis. Data concerning endothelium-related proteins are concordant with the co-existence of a chronic in vivo endothelial activation and endothelial injury in uremia. This could be linked to the initiation and progression of atherosclerosis.
Gris
J C
JC
Department of Haematology, CHU, Nîmes, France.
Branger
B
B
Vécina
F
F
al Sabadani
B
B
Fourcade
J
J
Schved
J F
JF
D000293:Adolescent; D000328:Adult; D000368:Aged; D001161:Arteriosclerosis / Q000503:physiopathology; D001779:Blood Coagulation Factors / Q000032:analysis; D002318:Cardiovascular Diseases / Q000209:etiology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000378:metabolism* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010960:Plasminogen Activators / Q000097:blood*; D015849:Plasminogen Inactivators / Q000097:blood*; D011446:Prospective Studies; D006435:Renal Dialysis; D012307:Risk Factors; D014511:Uremia / Q000378:metabolism / Q000628:therapy
D001779:Blood Coagulation Factors; D015849:Plasminogen Inactivators; D010960:Plasminogen Activators