title: Effect of time on dialysis and renal transplantation on endothelial function: a longitudinal analysis.
abstract: BACKGROUND
  Soluble vascular cell adhesion molecule-1 (sVCAM-1) is a marker of endothelial injury and a potent predictor of cardiovascular mortality in patients with kidney failure on dialysis. The longitudinal effects of dialysis on endothelial dysfunction and in particular the effects of renal transplantation on markers of endothelial function including sVCAM-1 have not been well characterized.
  
  
  METHODS
  We used the Transplant Manitoba registry and biobank to assemble a retrospective cohort of all patients receiving a first kidney transplant between January 1, 2000, and December 31, 2005 (n=186). One hundred seventy-four patients had at least two serum samples pretransplant and at least two samples posttransplant. In total, 1,004 serial samples (median 5/patient) were analyzed. Factors associated with sVCAM-1 were examined using mixed linear models.
  
  
  RESULTS
  The sVCAM-1 levels increased progressively on dialysis (0.15 [0.10 to 0.20] ng/mL/day; P<0.0001), fell significantly within 1 month after transplantation (-625 ng/mL/day; P<0.0001) and continued to fall thereafter (-0.23 [-0.34 to -0.12] ng/mL/day). Smoking and heart failure were associated with higher sVCAM-1 levels, whereas transplantation was associated with lower sVCAM-1 levels. The relationship between sVCAM-1 and transplantation was not changed by multivariate adjustment.
  
  
  CONCLUSIONS
  Endothelial injury worsens over time on dialysis but improves significantly after renal transplantation.
authors.affiliation: 1 Section of Nephrology, University of Manitoba, Winnipeg, Manitoba, Canada. 2 Transplant Manitoba, Health Sciences Center, Winnipeg, Manitoba, Canada. 3 Cardiac Sciences Program, Saint Boniface General Hospital, Winnipeg, Manitoba, Canada. 4 Seven Oaks Hospital Research Centre, Winnipeg Manitoba, Canada. 5 Address correspondence to: Claudio Rigatto, M.D., FRCPC, MSc, Section of Nephrology - University of Manitoba, Renal Health Program - Seven Oaks General Hospital, 2PD02-2300 McPhillips Street, Winnipeg, MB R2V 3M3.
authors.forename: Joe
authors.initials: J
authors.lastname: Bueti
authors.forename: David
authors.initials: D
authors.lastname: Rush
authors.forename: Navdeep
authors.initials: N
authors.lastname: Tangri
authors.forename: Keren
authors.initials: K
authors.lastname: Mandelzweig
authors.forename: Yang
authors.initials: Y
authors.lastname: Xu
authors.forename: Brett
authors.initials: B
authors.lastname: Hiebert
authors.forename: Manish M
authors.initials: MM
authors.lastname: Sood
authors.forename: Paul
authors.initials: P
authors.lastname: Komenda
authors.forename: Peter
authors.initials: P
authors.lastname: Nickerson
authors.forename: Claudio
authors.initials: C
authors.lastname: Rigatto
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000209:etiology; D015331:Cohort Studies; D004730:Endothelium, Vascular / Q000293:injuries / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D016030:Kidney Transplantation; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D013997:Time Factors; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood
chemical_list: D015415:Biomarkers; D019010:Vascular Cell Adhesion Molecule-1