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Successful renal transplantation decreases aortic stiffness and increases vascular reactivity in dialysis patients.
Transplantation 2003; 76(11):1573-7T

Abstract

BACKGROUND

Patients with end-stage renal disease on dialysis have among the highest cardiovascular event rates documented. Abnormal nitric oxide (NO)-dependent endothelial reactivity and increased arterial stiffness are commonly described in hemodialysis (HD) patients. Measures of aortic stiffness--aortic pulse wave velocity (PWV) and augmentation index (AGI)--have been shown to be powerful predictors of survival on hemodialysis. It is not known how these parameters interfere with successful renal transplantation.

METHODS

PWV and aortic AGI (difference between the first and second systolic peak on the aortic pressure waveform divided by the pulse wave height) were determined from contour analysis of arterial waveforms recorded by applanation tonometry using a SphygmoCor device in 41 HD patients (20 men; age, 41.8 years) and in a control group of 20 patients with essential hypertension (HTA) (10 men; age, 43.6 years). Twenty of the HD patients (10 men; age, 39.7 years) received live-related renal transplants (RTx) and were restudied (3 months after RTx, normal serum creatinine). NO-dependent and NO-independent vascular reactivity were assessed by changes in AGI after challenges with inhaled salbutamol (SAL) and sublingual nitroglycerin (NTG), respectively.

RESULTS

AGI values were significantly lower in RTx patients compared with subjects on hemodialysis (15.9 +/- 13.9% vs. 27.9 +/- 11.9%, P<0.05), but similar to essential HTA controls (16.5 +/- 17%). Serial AGI measurements showed that successful renal transplantation is associated with a decrease in AGI in all cases, from a mean of 25.1 +/- 7.8% while on dialysis to 15.9 +/- 7.0% 3 months after transplantation (P<0.0001). The responsiveness to both endothelium-dependent stimuli (inhaled SAL) and endothelium-independent stimuli (sublingual NTG) was greater in transplant patients than in hemodialysis patients (SAL-induced decrease in AGI -82.3 +/- 65.7% vs. 45 +/- 72.3%, P<0.01; and NTG-induced decrease in AGI 197 +/- 108 vs. -129.0 +/- 215.5%, P<0.01). PWV values in dialysis patients (7.19 +/- 1.88 m/sec) were significantly higher than those measured in essential HTA patients (6.34 +/- 1.32 m/sec, P<0.05) with normal renal function (despite similar blood pressure levels). PWV after RTx was 6.59 +/- 1.62 m/sec, significantly different from pretransplantation (dialysis) values (P<0.05 for comparison) but similar to the control group of essential HTA patients.

CONCLUSIONS

Renal transplantation is associated with marked improvements in vascular structure and function to a profile comparable to essential HTA patients.

Authors+Show Affiliations

C I Parhon University Hospital, Dialysis and Transplantation Center, Iasi, Romania. acovic@xnet.roNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

14702526

Citation

Covic, A, et al. "Successful Renal Transplantation Decreases Aortic Stiffness and Increases Vascular Reactivity in Dialysis Patients." Transplantation, vol. 76, no. 11, 2003, pp. 1573-7.
Covic A, Goldsmith DJ, Gusbeth-Tatomir P, et al. Successful renal transplantation decreases aortic stiffness and increases vascular reactivity in dialysis patients. Transplantation. 2003;76(11):1573-7.
Covic, A., Goldsmith, D. J., Gusbeth-Tatomir, P., Buhaescu, I., & Covic, M. (2003). Successful renal transplantation decreases aortic stiffness and increases vascular reactivity in dialysis patients. Transplantation, 76(11), pp. 1573-7.
Covic A, et al. Successful Renal Transplantation Decreases Aortic Stiffness and Increases Vascular Reactivity in Dialysis Patients. Transplantation. 2003 Dec 15;76(11):1573-7. PubMed PMID: 14702526.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Successful renal transplantation decreases aortic stiffness and increases vascular reactivity in dialysis patients. AU - Covic,A, AU - Goldsmith,D J A, AU - Gusbeth-Tatomir,P, AU - Buhaescu,I, AU - Covic,M, PY - 2004/1/2/pubmed PY - 2004/1/22/medline PY - 2004/1/2/entrez SP - 1573 EP - 7 JF - Transplantation JO - Transplantation VL - 76 IS - 11 N2 - BACKGROUND: Patients with end-stage renal disease on dialysis have among the highest cardiovascular event rates documented. Abnormal nitric oxide (NO)-dependent endothelial reactivity and increased arterial stiffness are commonly described in hemodialysis (HD) patients. Measures of aortic stiffness--aortic pulse wave velocity (PWV) and augmentation index (AGI)--have been shown to be powerful predictors of survival on hemodialysis. It is not known how these parameters interfere with successful renal transplantation. METHODS: PWV and aortic AGI (difference between the first and second systolic peak on the aortic pressure waveform divided by the pulse wave height) were determined from contour analysis of arterial waveforms recorded by applanation tonometry using a SphygmoCor device in 41 HD patients (20 men; age, 41.8 years) and in a control group of 20 patients with essential hypertension (HTA) (10 men; age, 43.6 years). Twenty of the HD patients (10 men; age, 39.7 years) received live-related renal transplants (RTx) and were restudied (3 months after RTx, normal serum creatinine). NO-dependent and NO-independent vascular reactivity were assessed by changes in AGI after challenges with inhaled salbutamol (SAL) and sublingual nitroglycerin (NTG), respectively. RESULTS: AGI values were significantly lower in RTx patients compared with subjects on hemodialysis (15.9 +/- 13.9% vs. 27.9 +/- 11.9%, P<0.05), but similar to essential HTA controls (16.5 +/- 17%). Serial AGI measurements showed that successful renal transplantation is associated with a decrease in AGI in all cases, from a mean of 25.1 +/- 7.8% while on dialysis to 15.9 +/- 7.0% 3 months after transplantation (P<0.0001). The responsiveness to both endothelium-dependent stimuli (inhaled SAL) and endothelium-independent stimuli (sublingual NTG) was greater in transplant patients than in hemodialysis patients (SAL-induced decrease in AGI -82.3 +/- 65.7% vs. 45 +/- 72.3%, P<0.01; and NTG-induced decrease in AGI 197 +/- 108 vs. -129.0 +/- 215.5%, P<0.01). PWV values in dialysis patients (7.19 +/- 1.88 m/sec) were significantly higher than those measured in essential HTA patients (6.34 +/- 1.32 m/sec, P<0.05) with normal renal function (despite similar blood pressure levels). PWV after RTx was 6.59 +/- 1.62 m/sec, significantly different from pretransplantation (dialysis) values (P<0.05 for comparison) but similar to the control group of essential HTA patients. CONCLUSIONS: Renal transplantation is associated with marked improvements in vascular structure and function to a profile comparable to essential HTA patients. SN - 0041-1337 UR - https://www.unboundmedicine.com/medline/citation/14702526/Successful_renal_transplantation_decreases_aortic_stiffness_and_increases_vascular_reactivity_in_dialysis_patients_ L2 - http://dx.doi.org/10.1097/01.TP.0000086343.32903.A8 DB - PRIME DP - Unbound Medicine ER -