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Oral L-arginine does not improve endothelial dysfunction in children with chronic renal failure
Katy J Bennett-Richards1, Mia Kattenhorn, Ann E Donald
1Departments of Nephrourology and Vascular Physiology, Great Ormond Street Hospital for Children NHS Trust, 34 Great Ormond Street, London WC1 3JH, England, United Kingdom. KatyJBR@aol.com
Insights
Dietary L-arginine supplementation did not improve endothelial function in children with chronic renal failure (CRF). This study suggests L-arginine is not a clinically useful approach for these patients.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Health
- Nutritional Science
Background:
- Cardiovascular disease is a leading cause of mortality in pediatric patients with chronic renal failure (CRF).
- L-arginine supplementation is explored for its potential to enhance nitric oxide (NO) bioavailability and mitigate atherosclerosis progression.
- Previous animal studies suggest L-arginine may attenuate atherosclerosis, prompting investigation in children with CRF.
Purpose of the Study:
- To evaluate the efficacy of oral L-arginine supplementation in improving endothelial function in children diagnosed with CRF.
- To assess the impact of L-arginine on nitric oxide-dependent endothelial response to shear stress in pediatric CRF patients.
Main Methods:
- A randomized, double-blind, placebo-controlled, crossover trial involving 21 children with CRF (aged 7-17 years).
- Assessed endothelial function using high-resolution ultrasound to measure brachial artery diameter changes in response to increased flow and glyceryl trinitrate.
- Administered L-arginine (2.5 or 5 g/m(2) x 3/day) or placebo for 4 weeks, with a 4-week washout period between treatments.
Main Results:
- Oral L-arginine significantly increased plasma L-arginine levels (82 to 179 micromol/L).
- No significant improvement was observed in endothelial-dependent vasodilation following L-arginine supplementation (7.96% to 7.71%).
- Endothelial-independent vasodilation also showed no significant change, indicating no improvement from L-arginine treatment.
Conclusions:
- Dietary L-arginine supplementation failed to improve endothelial function in children with chronic renal failure.
- The findings suggest that L-arginine supplementation is not a clinically beneficial strategy for managing endothelial dysfunction in this pediatric population.
- Further research may be needed to explore alternative interventions for cardiovascular risk reduction in children with CRF.
Background:
Cardiovascular disease is a major cause of mortality amongst patients with chronic renal failure (CRF). L-arginine has been used to improve endothelial function by increasing nitric oxide (NO) bioavailability and in animal models this in turn has attenuated the progression of atherosclerosis. We examined whether dietary L-arginine supplementation improved endothelial function in children with CRF.
Methods:
A randomized, double-blind, placebo-controlled, crossover trial of L-arginine was conducted in 21 normotensive children aged 11.5 +/- 3 (7 to 17) years with CRF (GFR 27.4 +/- 13.2 mL/min/1.73 m(2)) in whom endothelial dysfunction had previously been demonstrated. We examined the effect of L-arginineon the endothelial response to shear stress (NO-dependent) using a non-invasive technique of high-resolution ultrasound. Each subject was studied before and after 4 weeks of L-arginine (2.5 g/m(2) or 5 g/m(2) x 3/day) or placebo, separated by a rest period of 4 weeks. Brachial artery diameter was measured at rest, during increased flow (endothelial-dependent dilation) and after 25 microg of glyceryl trinitrate (endothelial-independent dilation) at each visit.
Results:
After oral L-arginine, plasma L-arginine levels rose from 82 +/- 20 to 179 +/- 110 micromol/L (P < 0.001). No significant change in endothelial-dependent dilation during L-arginine (7.96 +/- 2.35 to 7.71 +/- 3.22%; P> 0.05) or placebo (8.2 +/- 2.89 to 8.3 +/- 3.14%; P> 0.05) was noted. There was no change in endothelial-independent dilation.
Conclusion:
Endothelial function was not improved with L-arginine, suggesting that dietary supplementation is not a useful clinical approach in children with CRF.