Hemodynamics and function of resistance arteries in healthy persons and end stage renal disease patients.
BACKGROUND
Cardiovascular disease is the leading cause of death in patients with end stage renal disease (ESRD). The vasodilator mechanisms in small resistance arteries are in earlier studies shown to be reduced in patients with end stage renal disease. We studied whether endothelium dependent vasodilatation were diminished in ESRD patients and the interaction between the macro- and microcirculation.


METHODS
Eleven patients with ESRD had prior to renal transplant or insertion of peritoneal dialysis catheter measured pulse wave velocity. During surgery, a subcutaneous fat biopsy was extracted. Resistance arteries were then dissected and mounted on a wire myograph for measurements of dilator response to increasing concentrations of acetylcholine after preconstriction with noradrenaline. Twelve healthy kidney donors served as controls.


RESULTS
Systolic blood pressure was elevated in patients compared to the healthy controls; no difference in the concentration of asymmetric dimethyl arginine was seen. No significant difference in the endothelium dependent vasodilatation between patients and controls was found. Correlation of small artery properties showed an inverse relationship between diastolic blood pressure and nitric oxide dependent vasodilatation in controls. Pulse pressure was positively correlated to the total endothelial vasodilatation in patients. A negative association between S-phosphate and endothelial derived hyperpolarisation-like vasodilatation was seen in resistance arteries from controls.


CONCLUSIONS
This study finds similar vasodilator properties in kidney patients and controls. However, correlations of pulse pressure and diastolic blood pressure with resistance artery function indicate compensating measures in the microcirculation during end stage renal disease.
Department of Biomedicine, Aarhus University, Aarhus, Denmark.
Morten K
MK
Borg
Department of Renal Medicine, Aarhus University Hospital and Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.
Per
P
Ivarsen
Department of Biomedicine, Aarhus University, Aarhus, Denmark.
Emil
E
Brøndum
Department of Renal Medicine, Aarhus University Hospital and Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.
Johan V
JV
Povlsen
Department of Biomedicine, Aarhus University, Aarhus, Denmark.
Christian
C
Aalkjær
D000109:Acetylcholine / Q000494:pharmacology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000187:drug effects / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology; D004730:Endothelium, Vascular / Q000187:drug effects / Q000503:physiopathology; D005260:Female; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology* / Q000601:surgery / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009213:Myography; D009638:Norepinephrine / Q000494:pharmacology; D063177:Pulse Wave Analysis; D006435:Renal Dialysis; D014655:Vascular Resistance / Q000187:drug effects / Q000502:physiology*; D014664:Vasodilation / Q000187:drug effects / Q000502:physiology*; D055815:Young Adult
D000109:Acetylcholine; D009638:Norepinephrine