THE INFLUENCE OF LIPID SPECTRUM INDICES ON THE ENDOTHELIUM! DEPENDENT AND ENDOTHELIUM-INDEPENDENT VASODILATATION IN PATIENTS WITH DIFFERENT STAGES OF CHRONIC RENAL FAILURE

THE AIM of the work was to study the interrelationship between the blood lipid level and endothelium function in patients with chronic renal failure (CRF). PATIENTS AND METHODS. The group under study included patients with chronic pyelonephritis and hypertension variant of glomerulonephritis: 25 of them had normal function of the kidneys, 58 had predialysis stage of CRF and 27 had the endstage CRF receiving substitution therapy with hemodialysis (HD). All the patients had arterial hypertension. They received adequate hypotensive therapy. The patients under study had no clinical symptoms of ischemic heart disease (IHD) or atherosclerosis of the cerebral arteries, signs of exacerbation of the main kidney disease or coexistent pathology. HD was adequate (sKt/V>1.2). Cholesterol, low density lipoprotein cholesterol (LDLPC), high density lipoprotein cholesterol (HDLPC), triglycerides, endotheliumdependent vasodilatation (EDV) and endotheliumindependent vasodilatation (EIV) were determined. RESULTS. General cholesterol was somewhat higher in patients without CRF and with the predialysis stage of CRF, while in the group of HD patients it was within the normal. Mean values of LDLPC and HDLPC, triglycerides were within the normal. Reliable negative correlative interrelation was noted between EDV and blood triglyceride level. No reliable correlative interrelation was noted with general cholesterol, LDLPC and HDLPC. Reliable positive interrelation was detected between EIV and LDLPC having antiatherogenic properties. No relationships were detected between EIV and cholesterol level and LDLPC. CONCLUSION. It can be suggested that triglycerides represent the factor influencing the development of endothelial dysfunction in patients with different stages of CRF, while LDLPC have protective effects on the endothelium.

1. Celermajer DS, Sorensen KE, Spiegelhalter DJ et al. Aging is associated with endothelial dysfunction in healthy men years before the agerelated decline in women. J Am Coll Cardiol 1994;(24):471476

2. Celemajer DS, Adams MR, Clarcson P еt. al. Passive smoking and impaired endothelium –dependent responses in humans. Am J Cardiol 1996;(93):13461353

3. Giannattasio C, Mngoni AA, Failla M. et. al. Impaired radial artery compliance in normotensive subject with familial hypercholesterolemia. Atherosclerosis 1996;(124):249260

4. Гогин ЕЕ. Курение, эндотелий и гипертоническая болезнь. Клиническая медицина 1998;(11):1013

5. Shinozaki K, Hirayama A, Nishio Y et al. Coronary endothelial dysfunction in the insulinresistant state is linked to abnormal pteridine metabolism and vascular oxidative stress. J Am Coll Cardiol 2001; 38(7):18211828

6. Arcaro G, Cretti A, Balzano S et al. Insulin causes endothelial dysfunction in humans: sites and mechanisms. Circulation 2002; 105(5):576582

7. Ghiadoni L, Donald AE, Cropley M et al. Mental stress induces transient endothelial dysfunction in humans. Circulation 2000; 102(20): 24732478

8. Al Suwaidi J, Higano ST, Holmes DR et al. Obesity is independently associated with coronary endothelial dysfunction in patients with normal or mildly diseased coronary arteries. J Am Coll Cardiol 2001; 37(6): 15231528

9. Liuba P, Karnani P, Pesonen E et al. Endothelial dysfunction after repeated Chlamydia pneumoniae infection in apolipoprotein Eknockout mice. Circulation 2000; 102(9):1039 1044

10. Fichtlscherer S, Rosenberger G, Walter DH et al. Elevated Creactive protein levels and impaired endothelial vasoreactivity in patients with coronary artery disease. Circulation 2000; 102(9):10001006

11. Lundman P, Eriksson MJ, Stuhlinger M et al. Mildto moderate hypertriglyceridemia in young men is associated with endothelial dysfunction and increased plasma concentrations of asymmetric dimethylarginine. J Am Coll Cardiol 2001;38(1):111116

12. Bostom AG, Culleton BF. Hyperhomocysteinemia in chronic renal disease. J Am Soc Nephrol 1999, 10(4):891900

13. Vallance P, Leone A, Calver A et al. Accumulation of an endogenous inhibitor of nitric oxide synthesis in chronic renal failure. Lancet 1992; (339):572575

14. Joznnides R, Bakkali EN, Le Roy F et al. Altered flow dependent vasodilatation of conduct arteries in maintenance haemodialysis. Nephrol Dial Transpalant 1997;12: 2623 – 2628

15. Kari JA, Donald AE, Vallance DT et al. Physiology and biochemistry of endothelial function in children with chronic renal failure. Kidney Int 1997;52 (2):468472

16. Kosch M, Levers A, Barenbrock M et al. Acute effects of haemodialysis on endothelial function and large artery elasticity. Nephrol Dial Transplant 2001; (16):16631668

17. Yand MF, William GH, Webb DJ. Hemodialysis and L arginin, but not Darginin, correct renal failureassociated endothelial dysfunction. Kidney Int 1998; 53(4):10681077

18. Затейщикова А.А,.Затейщиков Д.А. Эндотелиальная регуляция сосудистого тонуса: методы исследования и клиническое значение. Кардиология 1998;(9):68 – 80

19. Насонов ЕЛ, Баранов АА. Маркеры активации эндотелия (тромбомодулин, антиген фактора Виллебранта и ангиотензинпревращающий фермент): клиническое значение. Клин мед 1998; (11): 4 – 7

20. Boger RH, BodeBoger SM, Thiele W et al. Biochemical evidence for impaired nitric oxide synthesis in patients with peripheral arterial occlusive disease. Circulation 1997;95(8):20682074

21. Quyyumi AA, Dakak N, Andrews NP et al. Nitric oxide activity in the human coronary circulation. Impact of risk factors for coronary atherosclerosis. J Clin Invest 1995; 95(4):17471755

22. Lacy CR, Contrada RJ, Robbins ML et al. Coronary vasoconstriction induced by mental stress (simulated public speaking). Am J Cardiol 1995; 75(7): 503505

23. Halcox JP, Schenke WH, Zalos G et al. Prognostic value of coronary vascular endothelial dysfunction. Circulation 2002; 106(6):653658

24. Cardillo C, Kilcoune CM, Cannon RO et al. Xanthine oxidase inhibition with oxypurinol improves endothelial vasodilatator function in hypercholesterolemic but not in hypertensive patients. Hypertension 1997; (30):5763