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• W2011127573 abstract "Impaired endothelial and microvascular function and vascular compliance can accelerate atherosclerosis in end-stage renal disease (ESRD). When ESRD patients receiving conventional intermittent hemodialysis (IHD) are converted to nocturnal home hemodialysis (NHD), within 1-2 months the resultant increase in dialysis dose restores both absent brachial artery endothelium-dependent (hyperemia) and markedly impaired endothelium-independent (nitroglycerine; NTG) vasodilatation. We tested the hypothesis that coronary vasodilator responsiveness is also enhanced by NHD. 24 patients (mean age 52 [range 27-68]) requiring diagnostic coronary angiography were studied (5 control [not ESRD], 11 IHD, 8 NHD). IHD patients (3 four-hour sessions/week) had been on dialysis for 24 (range 3-55) months vs. 31 (range 8-71) months for NHD (6 twelve-hour sessions/week) patients. Following angiography and systemic heparin, a Doppler wire (intracoronary [IC] flow velocity) and ‘transit' infusion catheter (for direct IC infusion) were advanced down the left anterior descending. After baseline measurements, adenosine was infused IC (2.4 mg/min) though the transit catheter for 2 min followed by 200 ug IC bolus. After hemodynamic and Doppler flow parameters returned to baseline, patients received a 200 ug IC NTG bolus, and lastly 0.4 mg sublingual (SL) NTG tablet. Coronary flow reserve (CFR) was calculated as the average peak to baseline IC flow velocity ratio. Drug-induced changes in mean luminal diameter (MLD) were measured blindly (QCA). Coronary flow reserve was greater in NHD patients (3.38 vs. 2.27 in IHD; P = 0.004), but nonetheless impaired relative to controls (3.38 vs. 5.01;P = 0.05). Compared with baseline, adenosine IC bolus increased MLD in NHD patients by 11.2% vs. 4.1% in IHD (P = 0.006). NTG IC bolus and NTG SL increased MLD by 13.3% and by 14.6% in NHD patients vs. by 8.4% and 4.1% respectively in IHD patients (P < 0.05 for both). The mean arterial blood pressure (MAP) response to SL NTF was attenuated in IHD vs. NHD patients (−5.2% vs. −12.8%; P < 0.05). Coronary vasodilator responses to adenosine and NTG are markedly attenuated in IHD patients compared with NHD patients, indicating that enhanced uremic clearance through intensified hemodialysis can improve (but not necessarily normalize) microvascular function. The contrasting MAP effects of SL NTG indicate blood pressure responsiveness to NO donors is also augmented by NHD; such patients may receive greater acute benefit from nitrate prescription for angina. Improvement in endothelial function with enhanced uremia clearance may slow the rate at which atherosclerosis progresses in ESRD, a population at high cardiovascular risk." @default.
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• W2011127573 date "2011-09-01" @default.
• W2011127573 modified "2023-10-17" @default.
• W2011127573 title "144 Comparison of coronary vasoreactivity in end-stage renal disease patients receiving conventional intermittent vs. nocturnal hemodialysis" @default.
• W2011127573 doi "https://doi.org/10.1016/j.cjca.2011.07.102" @default.
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