title: Flow-mediated vasodilation in end-stage renal disease.
abstract: OBJECTIVE
  An intact endothelium is essential for adaptations between arterial vasomotor tone and shear stress (SS), i.e., flow-mediated vasodilation (FMD). Endothelial dysfunction occurs in hypertension, cardiac insufficiency, diabetes, atherosclerosis, and in end-stage renal disease (ESRD) patients, whose renal failure is associated with many of those cardiovascular diseases (CVD).
  
  
  METHODS
  Using a progressive hand-warming protocol and repeated measures ANOVA, we analyzed SS-mediated increase of brachial artery diameter (ΔBA) in 22 healthy controls, 18 CVD-negative ESRD patients (ESRD-CVD(-)), and 17 CVD-positive ESRD patients (ESRD-CVD(+)) to analyze the role of uremia versus CVD on FMD.
  
  
  RESULTS
  Hand-warming increased SS (P < 0.001) and ΔBA (P < 0.001). Negative interactions were observed between ΔBA and ESRD (P < 0.001), and between ΔBA and CVD(+) (P < 0.02), but there was no interaction between ESRD and CVD(+) (P = 0.69). For low and mild SS increases, ESRD-CVD(-) patients were characterized by similar ΔBA as controls, but it was lower than controls at higher SS (P < 0.01). In ESRD-CVD(+) patients, brachial artery diameter did not respond to mild and moderate SS increases, and showed "paradoxical" vasoconstriction at higher SS (P < 0.05). In ESRD, a positive and independent interaction was observed between ΔBA and 25(OH) vitamin D(3) insufficiency (≤15 μg/L; P < 0.02).
  
  
  CONCLUSIONS
  These observations indicate that, independently of each other, ESRD and CVD(+) history are associated with endothelial dysfunction. They also suggest the importance of considering the relationships between SS and endothelial function in different clinical conditions.
authors.affiliation: Hôpital F.H. Manhès, 8 rue Roger Clavier, 91712 Fleury-Mérogis CEDEX, France.
authors.forename: Francis H
authors.initials: FH
authors.lastname: Verbeke
authors.forename: Bruno
authors.initials: B
authors.lastname: Pannier
authors.forename: Alain P
authors.initials: AP
authors.lastname: Guérin
authors.forename: Pierre
authors.initials: P
authors.lastname: Boutouyrie
authors.forename: Stephane
authors.initials: S
authors.lastname: Laurent
authors.forename: Gérard M
authors.initials: GM
authors.lastname: London
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001916:Brachial Artery / Q000503:physiopathology*; D002318:Cardiovascular Diseases / Q000503:physiopathology*; D016022:Case-Control Studies; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006358:Hot Temperature; D006801:Humans; D007101:Immersion; D007676:Kidney Failure, Chronic / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D014511:Uremia / Q000503:physiopathology; D014664:Vasodilation