Endothelial Function in End-Stage Renal Disease (ESRD) and Dialysis Patients: Possible Role of Erythropoietin Hormone Treatment in Experimental Animals
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- Category: Vol. 78, June 2010
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Endothelial Function in End-Stage Renal Disease (ESRD) and Dialysis Patients: Possible Role of Erythropoietin Hormone Treatment in Experimental Animals,MAHA M. GAMAL, LAILA A. EL-SAYED, NOHA A. IBRAHIM and NAGWA M. RAMADAN
Abstract
In this study we tried to assess the endothelial dysfunction using von Willebrand factor (vWF) in end stage renal failure (ESRD) patients and to clarify the role of dialysis in the progression of endothelial injury. In addition, we tried to evaluate the possible role of erythropoietin therapy on pro-gression of endothelial injury.
To achieve this, the study was designed on 2 modules; humans and animals.
The Human Study: Thirty subjects were included in this study and classified into three groups:
Group (I): Control group (n=10).
Group (II): ESRD patients pre-dialysis group (n=10). Group (III): ESRD patients dialysis group (n=10).
For all subjects the following parameters were measured: Blood pressure, blood hemoglobin, serum urea and creatinine, serum cholesterol and triglycerides and plasma vWF.
The Animal Study: Thirty male albino rats, of an average weight 150-200 gm were included in this study and divided into three groups, 10 rats each:
Group (I): Control group (sham operated rats).
Group (II): Experimentally induced renal failure group: In the rats of this group chronic renal failure (CRF) was induced, and the animals were kept for 6 weeks after which blood samples were taken.
Group (III): Experimentally induced renal failure group with erythropoietin (EPO) hormone therapy. At the end of the 6 weeks the following measures were carried out for all groups: Renal function was assessed by measuring serum urea and creatinine and endothelial dysfunction was evaluated by measuring plasma vWF. Our results showed significantly increased plasma vWF in all ESRD patients (both the pre-dialysis and the dialysis groups) denoting the presence of endothelial dysfunction in these patients. The increase in vWF concentrations directly correlated with those of urea, creatinine, Hb and triglycerides, but did not correlate with cholesterol. However, when the pre-dialysis and the dialysis groups were compared together, there was a significant decrease in plasma vWF in the dialysis group. This provided an evidence for improvement of endothelial dysfunction by hemodialysis. In addition; this study revealed that treatment of uremic anemia by erythropoietin hormone (studied in experimental animals) was accompanied by significant reduction in plasma vWF. The reduction in vWF concentration was positively correlated with those of urea and creatinine. This suggests a beneficial role for erythropoietin therapy on progression of endothelial injury.
In Conclusion: This study demonstrated the presence of endothelial dysfunction in ESRD patients and provided an evidence for the beneficial role of hemodialysis on this endothelial injury. It also suggests that therapeutic strategies targeting endothelial function might theoretically reduce the burden of cardiovascular disease in ESRD. In addition, the use of rHuEPO was likely to improve the endothelial function in CRF rats.