TY - JOUR
T1 - Inflammatory and Angiogenic Factors Linked to Longitudinal Microvascular Changes in Hemodialysis Patients Irrespective of Treatment Dose Intensity
AU - Mitsides, Nicos
AU - Cornelis, Tom
AU - Broers, Natascha J. H.
AU - Diederen, Nanada M. P.
AU - Brenchley, Paul
AU - Heitink-ter Braak, Nicole
AU - van der Sande, Frank M.
AU - Schalkwijk, Casper G.
AU - Kooman, Jeroen P.
AU - Mitra, Sandip
PY - 2017
Y1 - 2017
N2 - Background: Cardiovascular disease is a major contributor to the poor outcomes observed in hemodialysis. We investigated the relationship between hemodialysis intensity and vascular parameters in high-dose (HDHD; > 12hrs/week) and Conventional (CHD; = 12hrs/week) hemodialysis intensity over a 6-month period. Methods: We present the 6-month longitudinal analysis of a 2-year multicenter study investigating the effects of HDHD on cardiovascular parameters. We used pulse wave velocity, 24hr ambulatory blood pressure and sublingual dark field capillaroscopy measurements to assess macro-and microcirculation on 6-monthly basis. Pro-inflammatory and endothelial biomarkers were also measured at 6-monthly intervals. Results: 47 participants (21 HDHD, 26 CHD) were studied. CHD were older (63.5 +/- 14.2 vs 53.7 +/- 12.6 yr; p = 0.018), with shorter dialysis vintage (median 23 vs 61 months; p = 0.001). There was considerable variability in the degree and direction of change of circulatory measurements over a 6-month period. Hemodialysis intensity (hrs/week) did not correlate to these changes, when adjusted for age, dialysis vintage and comorbidity. Higher levels of Interleukin (IL)-8 measured at baseline independently predicted an increase in the Perfused Boundary Region (5-25 mu m) of the endothelial glycocalyx (p=0.010) whilst higher levels of soluble Flt-1 had a significant inverse effect (p=0.002) in an adjusted linear model. Conclusion: Hemodialysis intensity did not predict changes in either macro-or microvascular parameters. Inflammation mediated through the IL-8 pathway predicted microvascular injury while Flt-1, a potential marker of angiogenesis and endothelial repair, might have a significant protective role. Further understanding of these pathways will be necessary to improve dialysis outcomes. (C) 2017 The Author(s) Published by S. Karger AG, Basel
AB - Background: Cardiovascular disease is a major contributor to the poor outcomes observed in hemodialysis. We investigated the relationship between hemodialysis intensity and vascular parameters in high-dose (HDHD; > 12hrs/week) and Conventional (CHD; = 12hrs/week) hemodialysis intensity over a 6-month period. Methods: We present the 6-month longitudinal analysis of a 2-year multicenter study investigating the effects of HDHD on cardiovascular parameters. We used pulse wave velocity, 24hr ambulatory blood pressure and sublingual dark field capillaroscopy measurements to assess macro-and microcirculation on 6-monthly basis. Pro-inflammatory and endothelial biomarkers were also measured at 6-monthly intervals. Results: 47 participants (21 HDHD, 26 CHD) were studied. CHD were older (63.5 +/- 14.2 vs 53.7 +/- 12.6 yr; p = 0.018), with shorter dialysis vintage (median 23 vs 61 months; p = 0.001). There was considerable variability in the degree and direction of change of circulatory measurements over a 6-month period. Hemodialysis intensity (hrs/week) did not correlate to these changes, when adjusted for age, dialysis vintage and comorbidity. Higher levels of Interleukin (IL)-8 measured at baseline independently predicted an increase in the Perfused Boundary Region (5-25 mu m) of the endothelial glycocalyx (p=0.010) whilst higher levels of soluble Flt-1 had a significant inverse effect (p=0.002) in an adjusted linear model. Conclusion: Hemodialysis intensity did not predict changes in either macro-or microvascular parameters. Inflammation mediated through the IL-8 pathway predicted microvascular injury while Flt-1, a potential marker of angiogenesis and endothelial repair, might have a significant protective role. Further understanding of these pathways will be necessary to improve dialysis outcomes. (C) 2017 The Author(s) Published by S. Karger AG, Basel
KW - Hemodialysis
KW - Endothelium
KW - IL-8
KW - TNF-alpha
KW - CHRONIC KIDNEY-DISEASE
KW - C-REACTIVE PROTEIN
KW - PERITONEAL-DIALYSIS PATIENTS
KW - RANDOMIZED-CONTROLLED-TRIAL
KW - NECROSIS-FACTOR-ALPHA
KW - TYROSINE KINASE 1
KW - CARDIOVASCULAR RISK
KW - ARTERIAL STIFFNESS
KW - CONVENTIONAL HEMODIALYSIS
KW - ENDOTHELIAL GLYCOCALYX
UR - https://karger.figshare.com/articles/dataset/Supplementary_Material_for_Inflammatory_and_Angiogenic_Factors_Linked_to_Longitudinal_Microvascular_Changes_in_Hemodialysis_Patients_Irrespective_of_Treatment_Dose_Intensity/5607106/1
U2 - 10.1159/000485048
DO - 10.1159/000485048
M3 - Article
C2 - 29145197
SN - 1420-4096
VL - 43
SP - 905
EP - 918
JO - Kidney & Blood Pressure Research
JF - Kidney & Blood Pressure Research
IS - 5
ER -