Key result
Hemodialysis is linked to impaired supine blood flow response compared to healthy controls.
Why the study?
Chronic kidney disease is associated with impaired endothelial function, but its involvement in the circulatory response to orthostatic stress is unknown.
Does orthostatic stress reveal impaired brachial artery endothelial flow-mediated dilation in hemodialysis patients compared to controls?
Observational (n=122)
Does orthostatic stress reveal impaired brachial artery endothelial flow-mediated dilation in hemodialysis patients compared to controls?
Absolute Event Rate: 158.8% vs 195.1%
p-value: p=0.04
Hemodialysis patients exhibit impaired endothelial flow-mediated dilation both in the supine position and during orthostatic stress compared to controls, suggesting a role of uremia in vascular dysfunction.
Impaired endothelial function in hemodialysis patients may heighten vascular risk; hypothesis-generating and requires prospective validation before clinical use.
PURPOSE: Chronic kidney disease (CKD) is associated with an impaired endothelial function, which may contribute to cardiovascular events. Whether impairment in endothelial function is involved in the circulatory response to orthostatic stress is unknown. We assessed endothelial function via brachial artery flow-mediated dilation (BAFMD), an index of endothelial-dependent vasodilation. METHODS: We measured changes in brachial artery diameter (BAD) and blood flow by Doppler ultrasound in 35 CKD patients on hemodialysis, 37 young healthy controls (HC) and 50 non-uremic matched controls (MC), in the supine position and after 60 degrees head-up tilting (HUT). RESULTS: In the supine position, endothelial flow-mediated BAD was significantly increased in HC (p<0.001) and MC (p<0.01) while no significant changes were detected in CKD. Mean percent blood flow changes were HC+323.5%, MC+195.1% and CKD+158.8% (HC vs. CKD p<0.001; HC vs. MC p<0.001; MC vs. CKD p=0.04). Similarly, during HUT mean BAD and blood flow increases were significantly impaired in CKD patients. CONCLUSION: In CKD patients, an impaired response in the physiologic vascular reactivity, suggesting endothelial dysfunction, was found in the supine position and after orthostasis by BAFMD. Our results are in favor of a possible adjunctive role of uremia in the abnormal brachial artery response.
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Gallieni et al. (2008) conducted an observational in Chronic kidney disease (n=122). Chronic kidney disease on hemodialysis vs. Non-uremic matched controls and young healthy controls was evaluated on Mean percent blood flow changes in the supine position (p=0.04). Chronic kidney disease patients on hemodialysis exhibited significantly impaired mean percent blood flow changes in the supine position compared to matched controls (+158.8% vs +195.1%, p=0.04).
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