Endothelial Dysfunction in ESRD Patients Starting Dialysis Treatment

Kim, Seung Jun; Lee, Jung Eun; Yoo, Dong Eun; Oh, Hyung Jung; Lee, Han Sung; Park, Sun Young; Moon, Sung Jin; Kim, Dong Ki; Han, Dae Suk; Kang, Shin Wook

Abstract

BACKGROUND
Patients with renal failure have increased cardiovascular risk due to accelerated atherosclerosis. Endothelial dysfunction (ED) appears to be an important initiating event in the process of atherogenesis. ED has been reported in patients receiving hemodialysis and peritoneal dialysis. However, there has been no study on ED in Korean ESRD patients starting dialysis treatment. In this study, ED was assessed in patients starting dialysis treatment and the risk factors of ED were analyzed.
METHODS
Among the patients diagnosed as terminal-stage renal disease (ESRD) and started dialysis treatment at Severance Hospital of Yonsei University College of Medicine from January, 2005 to December, 2005, 35 patients (ESRD group) (51.7+/-12.6 years-old, M:F=22:13) underwent Doppler ultrasonography to have their endothelial functions assessed. Flow-mediated dilation (FMD) was used as an index of ED. For the control group, 33 hypertensive patients (55.2+/-11.4 years-old, M:F=17:16) with normal renal function were selected and FMD was also measured.
RESULTS
FMD was significantly reduced in the ESRD group compared to the control group (3.8+/-1.9 vs. 4.9+/-2.4%, p<0.05). When the ESRD group was divided into either DM or non-DM group according to DM status, there was a significant difference in FMD between the two groups (DM, 3.1+/-1.9%; non-DM, 4.4+/-1.9%, p<0.05). In the ESRD group, FMD was inversely related to systolic blood pressure, mean arterial pressure, pulse pressure, and DM duration (p< 0.05).
CONCLUSION
ED was already present in patients at the time of starting dialysis treatment and was more severe in the DM compared the non-DM patients.