title: Vascular function and mortality in haemodialysis patients: a pilot study.
abstract: BACKGROUND
  Haemodialysis patients often have impaired vascular function that can contribute to mortality. Endothelial-dependent and -independent vascular function can be assessed using the brachial artery reactivity (BAR) technique that measures flow-mediated dilatation (FMD) and the response to glyceryl trinitrate (GTN), respectively.
  
  
  OBJECTIVE
  The aim of this pilot study was to determine whether BAR measurements in haemodialysis patients were associated with mortality.
  
  
  METHODS
  Brachial artery responses to FMD and administration of GTN were assessed in consecutive haemodialysis patients. Patients were then followed up to 18 months after BAR measurements.
  
  
  RESULTS
  Seventeen patients were included in the study. After 18 months of follow-up, patients were divided into two groups: survived (n=12) and deceased (n=5). Patients who survived had a significantly greater median percentage vasodilatation to GTN than those who died (19.1% vs 8.8%; P=0.04); and a significantly greater median area under the diameter change-time curve (318 vs 146 mm/s; P=0.03). However, there were no significant differences between survivors and deceased in median percentage vasodilation to FMD (6.0% vs 4.3%; P=0.21), time to peak dilation (45 vs 40s; P=0.66) or area under the diameter change-time curve (35.5 vs 20 mm/s; P=0.29).
  
  
  CONCLUSIONS
  In this pilot study in a small group of haemodialysis patients, endothelial-independent vasodilatory response to GTN was associated with mortality and was of better prognostic value than the endothelial-dependent response to FMD. This finding needs to be investigated in a larger cohort.
authors: University of Tasmania, School of Human Life Sciences, Australia.
authors: Brad S
authors: BS
authors: Dalton
authors: Robert G
authors: RG
authors: Fassett
authors: Dominic P
authors: DP
authors: Geraghty
authors: Rex
authors: R
authors: De Ryke
authors: Jeff S
authors: JS
authors: Coombes
mesh_terms: D000328:Adult; D000368:Aged; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin; D010865:Pilot Projects; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011793:Queensland; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality*; D015996:Survival Rate; D013648:Tasmania; D013997:Time Factors; D014463:Ultrasonography; D014664:Vasodilation; D014665:Vasodilator Agents; D055815:Young Adult
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin