Nephrol Dial Transplant (2003) 18: 892-898
© 2003 European Renal Association-European Dialysis and Transplant Association
Impaired renal function is associated with markers of endothelial dysfunction and increased inflammatory activity
1 Department of Internal Medicine, 3 Department of Clinical Chemistry and 4 Department of Nephrology, Institute for Cardiovascular Research, Vrije Universiteit Medical Centre, Amsterdam and 2 Department of Internal Medicine, Amphia Hospital (Langendijk), Breda, The Netherlands
Background. Patients with end-stage renal disease (ESRD) as well as those with mild renal insufficiency are at increased risk for the development of cardiovascular disease, which cannot be attributed entirely to traditional risk factors. Endothelial dysfunction and chronic inflammatory activity, two important phenomena in atherogenesis, can be found in ESRD. At present, it is unclear whether endothelial dysfunction and chronic inflammatory activity are related to renal function in the pre-dialysis stage.
Methods. In a cross-sectional, single-centre study, four groups of 20 subjects with renal function ranging from a normal, calculated creatinine clearance (>90 ml/min) to a pre-dialysis situation (<31 ml/min) were investigated. We measured markers of endothelial function [von Willebrand factor (vWf), soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), tissue-type plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1) and E-selectin (ES)], and markers of inflammatory activity [secretory phospholipase A2 (sPLA2) and C-reactive protein (CRP)]. Using these markers, composite endothelial function and inflammatory activity scores were constructed.
Results. Creatinine clearance correlated with the endothelial function score (r=-0.43, P<0.001), the inflammatory activity score (r=-0.53, P<0.05), vWf (r=-0.54, P<0.001), sVCAM-1 (r=-0.50, P<0.001), sPLA2 (r=-0.28, P<0.05), homocysteine (r=-0.61, P<0.001), age (r=-0.54, P<0.001) and blood pressure (r=-0.44, P<0.001). In multivariate analyses, creatinine clearance was an independent determinant of the endothelial function score (ß=-0.34, P=0.006), plasma vWf (ß=-0.37, P=0.022) and sICAM-1 (ß=-0.33, P=0.012). The relationship of creatinine clearance with sVCAM-1 and endothelial function score was not significant when plasma homocysteine was added to the model. Creatinine clearance was also a determinant of the inflammatory activity score (ß=-0.31, P=0.025) and sPLA2 (ß=-0.32, P=0.024), although this was no longer significant after correction for systolic blood pressure.
Conclusions. Renal dysfunction is associated with markers of endothelial dysfunction and inflammatory activity. Plasma homocysteine may be an intermediate factor in the relationship between endothelial dysfunction and renal function, while blood pressure may modulate the association between inflammatory activity and renal function.
Keywords: endothelial function; inflammatory activity; renal insufficiency; secretory phospholipase A2; vascular cell adhesion molecule-1; von Willebrand factor
Correspondence and offprint requests to: Frank Stam, Department of Internal Medicine, Vrije Universiteit Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. Email: f.stam{at}vumc.nl
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