title: Angiopoietin 2 and cardiovascular disease in dialysis and kidney transplantation.
abstract: BACKGROUND
  Accelerated atherosclerosis in patients with chronic kidney disease (CKD) is still incompletely understood. Angiopoietin 1 (Ang-1) and Ang-2 are 55-kDa antagonistic nonredundant gatekeepers of endothelial activation and thus are potential important factors in accelerated atherosclerosis. We aimed to study: (1) angiopoietin levels in patients treated by means of dialysis and kidney transplantation, (2) the association of altered angiopoietin levels with atherosclerosis, and (3) changes in altered levels after renal transplantation.
  
  
  METHODS
  Cross-sectional and longitudinal observational study.
  
  
  METHODS
  117 patients with CKD (61 hemodialysis [HD] patients, 24 peritoneal dialysis [PD] patients, and 32 renal transplant recipients) and 22 healthy controls.
  
  
  METHODS
  Treatment by means of HD or PD or renal transplantation versus healthy controls.
  
  
  RESULTS
  Serum Ang-1 and Ang-2 levels and ratio and changes in levels before and 3 months after transplantation. Correlations of angiopoietin levels with the presence and severity of coronary heart disease and peripheral arterial disease.
  
  
  METHODS
  Ang-1 and Ang-2 were measured in sera by using an immunoradiometric sandwich assay and enzyme-linked immunosorbent assay, respectively. Coronary heart disease was scored by using coronary angiography, and peripheral arterial disease, by using ultrasonography.
  
  
  RESULTS
  Ang-1 level was decreased in HD patients compared with controls (29.1 +/- 12 versus 45.3 +/- 11.5 ng/mL; P < 0.001). In contrast, Ang-2 level was increased (HD, 8.7 +/- 0.64; PD, 6.48 +/- 8.1 ng/mL versus controls, 0.88 +/- 0.43 ng/mL; P < 0.001). Ang levels in renal transplant recipients were not different from healthy controls. Longitudinally, individual Ang-2 levels decreased after kidney transplantation (P = 0.01). In addition, in patients with CKD, Ang-2 level correlated significantly with scores of coronary heart disease (r = 0.486; P < 0.001) and peripheral arterial disease (r = 0.648; P < 0.001).
  
  
  CONCLUSIONS
  Cross-sectional study design.
  
  
  CONCLUSIONS
  Circulating Ang-2 level was increased in patients treated with dialysis, although the mechanism is unknown. Kidney transplantation normalized circulating Ang-2 levels after 3 months. In addition, Ang-2 might be a mediator (and thus a marker) that accounts for accelerated atherosclerosis in dialysis patients.
authors.affiliation: Department of Medicine, Division of Nephrology and Hypertension, Medical School Hannover, Hannover, Germany. david.sascha@mh-hannover.de
authors.forename: Sascha
authors.initials: S
authors.lastname: David
authors.forename: Philipp
authors.initials: P
authors.lastname: Kümpers
authors.forename: Julian
authors.initials: J
authors.lastname: Hellpap
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Horn
authors.forename: Holger
authors.initials: H
authors.lastname: Leitolf
authors.forename: Hermann
authors.initials: H
authors.lastname: Haller
authors.forename: Jan T
authors.initials: JT
authors.lastname: Kielstein
mesh_terms: D042683:Angiopoietin-1 / Q000097:blood; D042702:Angiopoietin-2 / Q000097:blood*; D001706:Biopsy; D002318:Cardiovascular Diseases / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009391:Nephelometry and Turbidimetry; D011379:Prognosis; D006435:Renal Dialysis / Q000379:methods*; D012307:Risk Factors
chemical_list: D042683:Angiopoietin-1; D042702:Angiopoietin-2