title: Assessment of endothelial dysfunction in Asian Indian patients with chronic kidney disease and changes following renal transplantation.
abstract: BACKGROUND
  Endothelial dysfunction may explain increased cardiovascular risk in patients with chronic kidney disease (CKD).
  
  
  METHODS
  Brachial artery was imaged during reactive hyperemia (endothelium-dependent, flow-mediated dilatation, FMD) and during glyceryl trinitrate-mediated dilatation (nitroglycerine-mediated dilatation, NMD, endothelium-independent) in 108 patients with CKD and three months following renal transplantation (RT) in 60 of them.
  
  
  RESULTS
  Patients with CKD had significantly lower FMD vs. controls (9.1% vs. 18.3%, p < 0.001) while NMD was comparable (19.8% vs. 21.8%, p = ns). Impaired FMD (<4.5%) was observed in 26.8% patients with CKD and was more common in those on hemodialysis (HD; 28.4% vs. 15.4%) vs. those not on dialysis. FMD for patients with glomerular filtration rate (GFR) 15-60 vs. <15 mL/min/1.73 m(2) was 12.9% and 8.8% (p = 0.05; respectively -29% and -52% lower vs. controls), indicating reduced FMD with increasing CKD severity. There was +72% increase in FMD following RT (9.1 to 15.7%, p < 0.001) while mean NMD was unchanged. Following RT, only 3.3% had impaired FMD.
  
  
  CONCLUSIONS
  Patients with CKD have endothelial dysfunction as evidenced by reduced FMD. Decreased FMD indicating worsening endothelial function was noted with increasing severity of CKD. Within three months of RT, there was significant improvement in FMD, while NMD values did not change.
authors.affiliation: Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India.
authors.forename: Jugal
authors.initials: J
authors.lastname: Sharma
authors.forename: Aditya
authors.initials: A
authors.lastname: Kapoor
authors.forename: Ranjanee
authors.initials: R
authors.lastname: Muthu
authors.forename: Narayan
authors.initials: N
authors.lastname: Prasad
authors.forename: Archana
authors.initials: A
authors.lastname: Sinha
authors.forename: Roopali
authors.initials: R
authors.lastname: Khanna
authors.forename: Sudeep
authors.initials: S
authors.lastname: Kumar
authors.forename: Naveen
authors.initials: N
authors.lastname: Garg
authors.forename: Satyendra
authors.initials: S
authors.lastname: Tewari
authors.forename: Raj K
authors.initials: RK
authors.lastname: Sharma
authors.forename: Pravin
authors.initials: P
authors.lastname: Goel
mesh_terms: D000328:Adult; D000368:Aged; D001916:Brachial Artery / Q000473:pathology; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000209:etiology; D004730:Endothelium, Vascular / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000175:diagnosis* / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000601:surgery; D012307:Risk Factors; D055815:Young Adult
keywords: chronic kidney disease; endothelial dysfunction; flow-mediated dilation; renal transplantation