1. Endothelial dysfunction and low-grade inflammation in the transition to renal replacement therapy
- Author
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April C.E. van Gennip, Maarten H. L. Christiaans, Bernard Canaud, Frank M. van der Sande, Mariëlle A C J Gelens, Karlien J Ter Meulen, Jeroen B van der Net, Marc M. H. Hermans, Natascha J. H. Broers, Joris J. J. M. Wirtz, Jeroen P. Kooman, Remy J.H. Martens, Tom Cornelis, Frank Stifft, Constantijn J.A.M. Konings, Casper G. Schalkwijk, RS: Carim - V01 Vascular complications of diabetes and metabolic syndrome, Promovendi CD, RS: CARIM - R3 - Vascular biology, Interne Geneeskunde, RS: NUTRIM - R3 - Respiratory & Age-related Health, MUMC+: MA Nefrologie (9), RS: CARIM - R3.02 - Hypertension and target organ damage, RS: Carim - V02 Hypertension and target organ damage, RS: CARIM other, and RS: CARIM - R3.01 - Vascular complications of diabetes and the metabolic syndrome
- Subjects
Male ,CHRONIC KIDNEY-DISEASE ,HEMODIALYSIS ,Physiology ,medicine.medical_treatment ,030232 urology & nephrology ,Cardiovascular Diseases/blood ,030204 cardiovascular system & hematology ,Pathology and Laboratory Medicine ,Gastroenterology ,Biochemistry ,GLUCOSE ,Kidney Failure ,0302 clinical medicine ,Immune Physiology ,Chronic Kidney Disease ,DIALYSIS ,Medicine and Health Sciences ,Renal Transplantation ,Longitudinal Studies ,Renal Insufficiency ,Immune Response ,Kidney transplantation ,Innate Immune System ,OUTCOMES ,Multidisciplinary ,Endothelial Cells/pathology ,Kidney Failure, Chronic/blood ,Middle Aged ,C-REACTIVE PROTEIN ,Renal Replacement Therapy ,Chronic/blood ,Cardiovascular Diseases ,Nephrology ,Renal Dialysis/methods ,CARDIOVASCULAR-DISEASE ,Medicine ,Cytokines ,Female ,Hemodialysis ,Research Article ,Inflammation/blood ,medicine.medical_specialty ,Adhesion Molecules ,VON-WILLEBRAND-FACTOR ,Science ,Immunology ,Surgical and Invasive Medical Procedures ,Urinary System Procedures ,Peritoneal dialysis ,03 medical and health sciences ,Signs and Symptoms ,Renal Replacement Therapy/methods ,Renal Dialysis ,Diagnostic Medicine ,Internal medicine ,Medical Dialysis ,medicine ,Humans ,Renal replacement therapy ,Renal Insufficiency, Chronic ,Dialysis ,Inflammation ,business.industry ,TRANSPLANTATION ,Interleukins ,MORTALITY ,Endothelial Cells ,Biology and Life Sciences ,Organ Transplantation ,Molecular Development ,medicine.disease ,Uremia ,Transplantation ,Cross-Sectional Studies ,Immune System ,Kidney Failure, Chronic ,Renal Insufficiency, Chronic/blood ,business ,Biomarkers ,Biomarkers/blood ,Kidney disease ,Developmental Biology - Abstract
IntroductionEnd-stage renal disease (ESRD) strongly associates with cardiovascular disease (CVD) risk. This risk is not completely mitigated by renal replacement therapy. Endothelial dysfunction (ED) and low-grade inflammation (LGI) may contribute to the increased CVD risk. However, data on serum biomarkers of ED and LGI during the transition to renal replacement therapy (dialysis and kidney transplantation) are scarce.MethodsWe compared serum biomarkers of ED and LGI between 36 controls, 43 participants with chronic kidney disease (CKD) stage 5 non-dialysis (CKD5-ND), 20 participants with CKD stage 5 hemodialysis (CKD5-HD) and 14 participants with CKD stage 5 peritoneal dialysis (CKD5-PD). Further, in 34 and 15 participants repeated measurements were available during the first six months following dialysis initiation and kidney transplantation, respectively. Serum biomarkers of ED (sVCAM-1, E-selectin, P-selectin, thrombomodulin, sICAM-1, sICAM-3) and LGI (hs-CRP, SAA, IL-6, IL-8, TNF-α) were measured with a single- or multiplex array detection system based on electro-chemiluminescence technology.ResultsIn linear regression analyses adjusted for potential confounders, participants with ESRD had higher levels of most serum biomarkers of ED and LGI than controls. In addition, in CKD5-HD levels of serum biomarkers of ED and LGI were largely similar to those in CKD5-ND. In contrast, in CKD5-PD levels of biomarkers of ED were higher than in CKD5-ND and CKD5-HD. Similarly, in linear mixed model analyses sVCAM-1, thrombomodulin, sICAM-1 and sICAM-3 increased after PD initiation. In contrast, incident HD patients showed an increase in sVCAM-1, P-selectin and TNF-α, but a decline of hs-CRP, SAA and IL-6. Further, following kidney transplantation sVCAM-1, thrombomodulin, sICAM-3 and TNF-α were lower at three months post-transplantation and remained stable in the three months thereafter.ConclusionsLevels of serum biomarkers of ED and LGI were higher in ESRD as compared with controls. In addition, PD initiation and, less convincingly, HD initiation may increase levels of selected serum biomarkers of ED and LGI on top of uremia per se. In contrast to dialysis, several serum biomarkers of ED and LGI markedly declined following kidney transplantation.
- Published
- 2019
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