title: Nitroglycerin mediated dilation evaluated by ultrasound is associated with sTWEAK in hemodialysis patients.
abstract: OBJECTIVE
  The main cause of death in hemodialysis (HD) patients is cardiovascular disease. Ultrasound assessment of the brachial artery dysfunction is easily achievable and can non-invasively detect atherosclerosis in various stages. In HD patients the cardiovascular risk profile is different and the determinants of brachial arterial function can be distinct comparing with general population. The aim of the study is to assess the determinants of arterial brachial function (flow-mediated and nitroglycerin-mediated dilation) evaluated by ultrasound in HD patients and their relation with tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) described as atherosclerotic marker in chronic kidney disease patients.
  
  
  METHODS
  We conducted a cross-sectional observational study on 54 hemodialysis patients. We recorded clinical and biological data and we measured sTWEAK serum levels by ELISA. We evaluated the arterial brachial function by measurement of flow-mediated and nitroglycerin-mediated dilation, using B mode ultrasound.
  
  
  RESULTS
  The determinants of flow-mediated dilation were: Kt/V (r=0.47, p<0.001), LDL-cholesterol (r=0.29, p=0.04), and total cholesterol (r=0.31, p=0.02). Flow-mediated dilation correlated with nitroglycerin-mediated dilation (r=0.70, p<0.001). In multivariate analysis kt/V was the only significant predictor for flow-mediated dilation (p=0.04). Nitroglycerin-mediated dilation correlates with sTWEAK (r=-0.30, p=0.03), systolic blood pressure (r=-0.28, p=0.04) and pulse pressure (r=-0.31, p=0.02). In multivariate analysis sTWEAK was the only significant predictor for nitroglycerin-mediated dilation (p=0.04).
  
  
  CONCLUSIONS
  The main determinant of nitroglycerin-mediated dilation was sTWEAK. In addition, decreased nitroglycerin-mediated dilation was associated with higher systolic blood pressure and pulse pressure. The main determinant of FMD was Kt/V. Increased flow-mediated dilation was associated with better dialysis efficiency and high total cholesterol and LDL-cholesterol.
authors.affiliation: Department of Nephrology and Dialysis, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. crinaclaudiarusu@yahoo.ro.
authors.forename: Crina Claudia
authors.initials: CC
authors.lastname: Rusu
authors.affiliation: Institute of Clinical Urology and Renal Transplantation, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Liviu
authors.initials: L
authors.lastname: Ghervan
authors.affiliation: Nefromed Dialysis Center, Cluj-Napoca, Romania.
authors.forename: Simona
authors.initials: S
authors.lastname: Racasan
authors.affiliation: Department of Nephrology and Dialysis, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Ina
authors.initials: I
authors.lastname: Kacsa
authors.affiliation: Department of Nephrology and Dialysis, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Diana
authors.initials: D
authors.lastname: Moldovan
authors.affiliation: Department of Nephrology and Dialysis, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Alina
authors.initials: A
authors.lastname: Potra
authors.affiliation: Department of Informatics and Biostatistics, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Cosmina
authors.initials: C
authors.lastname: Bondor
authors.affiliation: 1st Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Florin
authors.initials: F
authors.lastname: Anton
authors.affiliation: Nefromed Dialysis Center, Cluj-Napoca, Romania.
authors.forename: Ioan Mihai
authors.initials: IM
authors.lastname: Patiu
authors.affiliation: Department of Nephrology and Dialysis, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Mirela Gherman
authors.initials: MG
authors.lastname: Caprioara
mesh_terms: D050197:Atherosclerosis / Q000097:blood / Q000000981:diagnostic imaging* / Q000209:etiology*; D015415:Biomarkers; D000074049:Cytokine TWEAK; D004452:Echocardiography / Q000187:drug effects* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin; D006435:Renal Dialysis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D048069:Tumor Necrosis Factors / Q000097:blood*; D014665:Vasodilator Agents
chemical_list: D015415:Biomarkers; D000074049:Cytokine TWEAK; C109743:TNFSF12 protein, human; D048069:Tumor Necrosis Factors; D014665:Vasodilator Agents; D005996:Nitroglycerin