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Assessment of Vascular Function in Patients With Chronic Kidney Disease
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Association of kidney function with changes in the endothelial surface layer.

Martijn J C Dane1, Meriem Khairoun, Dae Hyun Lee

  • 1Department of Nephrology, Einthoven Laboratory for Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands;, †Department of Physiology, Maastricht University Medical Center, Maastricht, The Netherlands, ‡Department of Nephrology, Nijmegen Centre for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

Clinical Journal of the American Society of Nephrology : CJASN
|January 25, 2014
PubMed
Summary

End-stage renal disease (ESRD) is linked to a diminished endothelial surface layer, crucial for blood vessel health. Successful kidney transplants restore this layer, unlike in cases of graft dysfunction.

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Area of Science:

  • Cardiovascular Research
  • Nephrology
  • Microcirculation

Background:

  • End-stage renal disease (ESRD) is characterized by endothelial dysfunction.
  • The endothelial glycocalyx (endothelial surface layer) plays a vital role in microcirculatory interactions.
  • Perturbations in the endothelial surface layer may influence disease progression in ESRD.

Purpose of the Study:

  • To investigate the association between renal function and endothelial surface layer dimensions.
  • To utilize a novel noninvasive sidestream-darkfield imaging method to measure the perfused boundary region (PBR).
  • To assess endothelial activation and shed endothelial surface layer components.

Main Methods:

  • Perfused boundary region (PBR) was measured using sidestream-darkfield imaging in control participants, ESRD patients, and kidney transplant recipients.
  • Participants included controls (n=10), ESRD patients (n=23), successful transplant recipients (n=12), and those with graft dysfunction (n=10).
  • ELISA was used to measure angiopoietin-2, syndecan-1, and soluble thrombomodulin.

Main Results:

  • ESRD patients exhibited a significantly larger PBR compared to controls, indicating reduced endothelial surface layer dimensions.
  • Elevated levels of syndecan-1 and soluble thrombomodulin were observed in ESRD patients.
  • Successful kidney transplantation normalized PBR to control levels, whereas graft dysfunction (interstitial fibrosis/tubular atrophy) was associated with an enlarged PBR and increased endothelial activation markers.
  • A significant correlation was found between PBR, angiopoietin-2, and estimated glomerular filtration rate (eGFR).

Conclusions:

  • Reduced renal function is strongly associated with diminished endothelial surface layer dimensions.
  • Successful kidney transplantation restores the endothelial surface layer to levels comparable to healthy individuals.
  • Monitoring endothelial surface layer integrity may offer insights into kidney transplant outcomes.