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Dialysis improves endothelial function in humans.
J M Cross1, A Donald, P J Vallance
1Centre for Clinical Pharmacology and Therapeutics, Department of Medicine, University College London, 5 University Street, London WC1E 6JJ, UK.
Summary
Hemodialysis improved endothelial function by reducing harmful toxins in patients with chronic kidney disease. This effect was temporary, highlighting the impact of dialyzable toxins on vascular health.
Area of Science:
- Nephrology
- Vascular Biology
- Cardiovascular Medicine
Background:
- Circulating toxins in chronic renal failure impair endothelial function, contributing to vascular disease.
- Dialysis aims to remove these toxins, but its effect on endothelial function requires further investigation.
Purpose of the Study:
- To determine if reducing plasma concentrations of dialyzable toxins improves endothelial function.
- To compare the acute effects of hemodialysis (HD) versus automated peritoneal dialysis (APD) on endothelial function.
Main Methods:
- Assessed endothelial function using brachial artery flow-mediated dilatation (FMD) via ultrasound in 16 HD and 14 APD patients.
- Measured plasma levels of endothelial inhibitors: asymmetric dimethyl-l-arginine and homocysteine.
- Evaluated FMD before and after a single dialysis session, comparing it to glyceryl trinitrate-induced dilatation.
Main Results:
- Hemodialysis significantly increased FMD (4.0% to 5.8%, P<0.002), an effect lasting 5 hours.
- Automated peritoneal dialysis showed no significant acute change in FMD (5.9% to 5.4%, P>0.5).
- Neither HD nor APD affected glyceryl trinitrate-induced dilatation, indicating specific improvement in flow-mediated endothelial function.
Conclusions:
- Short-term reduction of endothelial toxins via hemodialysis is linked to improved endothelial function.
- These findings suggest that dialyzable toxins negatively impact endothelial function, with effects that are rapidly reversible.