Endothelium-dependent vasodilatation is impaired in peritoneal dialysis patients.
BACKGROUND
Peritoneal dialysis (PD) patients have a high risk of cardiovascular mortality, which is not completely explained by conventional risk factors. Other factors related to chronic renal failure and/or dialysis treatment might lead to endothelial dysfunction, which is associated with an adverse cardiovascular outcome. One such factor is hyperhomocysteinaemia, which has a high prevalence in PD patients.


METHODS
A vessel wall movement detector system was used to investigate endothelium-dependent, flow-mediated, and endothelium-independent, glyceryl trinitrate-induced, vasodilatation of the brachial artery in 29 PD patients and 29 control subjects.


RESULTS
Endothelium-dependent vasodilatation was markedly reduced in the PD group: 5.7 +/- 1.0% vs 10.4 +/- 1.3% in the control group (P = 0.004). Endothelium-independent vasodilatation was not impaired. Plasma total homocysteine was elevated in the PD patients (45.2 +/- 6.2 micromol/l), but was not related to endothelium-dependent vasodilatation.


CONCLUSIONS
Chronic peritoneal dialysis patients have impaired endothelium-dependent vasodilatation, which may reflect an increased susceptibility for the development of atherosclerosis and thrombosis.
Department of Nephrology, Academic Hospital and Institute for Cardiovascular Research, Vrije Universiteit, Amsterdam, The Netherlands.
C
C
van Guldener
M J
MJ
Janssen
J
J
Lambert
M
M
Steyn
A J
AJ
Donker
C D
CD
Stehouwer
D001161:Arteriosclerosis / Q000209:etiology; D001916:Brachial Artery / Q000503:physiopathology; D016022:Case-Control Studies; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006710:Homocysteine / Q000097:blood; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology; D014664:Vasodilation / Q000502:physiology*
D006710:Homocysteine