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Nephrol Dial Transplant (2002) 17: 2159-2163
© 2002 European Renal Association-European Dialysis and Transplant Association

Cyclooxygenase inhibition improves endothelium-dependent vasodilatation in patients with chronic renal failure

Margus Annuk, Bengt Fellström and Lars Lind

Department of Medical Science, University Hospital, Uppsala, Sweden

Background. Some studies have demonstrated beneficial effects of L-arginine as a substrate for nitric oxide synthesis, and diclofenac as an inhibitor of cyclooxygenase (COX)-derived vasoconstrictive agents on vascular responses in humans during several pathological conditions. The aim of the present study was to investigate the acute effects of L-arginine and diclofenac on endothelium-dependent vasodilatation (EDV) and endothelium-independent vasodilatation (EIDV) in patients with chronic renal failure (CRF).

Methods. Effects of L-arginine and diclofenac on EDV and EIDV were measured in 15 patients with CRF and in 15 healthy controls by means of forearm blood flow measurements with venous occlusion plethysmography during local intra-arterial infusions of methacholine (2 and 4 µg/min evaluating EDV) and sodium nitroprusside (5 and 10 µg/min evaluating EIDV).

Results. L-Arginine infusion increased methacholine-induced vasodilatation both in patients with CRF and healthy controls. Diclofenac infusion increased methacholine-induced vasodilatation only in patients with CRF. There was no significant change in nitroprusside-induced vasodilatation after L-arginine and diclofenac infusions both in patients with CRF and healthy controls.

Conclusions. These results suggest that COX inhibition reduces the levels of a prostanoid-derived vasoconstrictive agent contributing to the impaired EDV in patients with CRF, while in this age group L-arginine improves EDV regardless of renal function.

Keywords: chronic renal failure; cyclooxygenase inhibition; endothelium; L-arginine

Correspondence and offprint requests to: Dr Margus Annuk, Department of Medical Science, Renal Unit, University Hospital, Uppsala SE 751 85, Sweden. Email: Margus.Annuk{at}medsci.uu.se


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